Permanent Pay, Originating Site Policies Boost Access to Virtual Addiction Services

December 20, 2021 - Lawmakers have the power to solidify access to virtual opioid use disorder treatment by introducing policies that ensure reimbursement parity, solidify audio-only telehealth coverage, and expand the list of eligible originating sites, according to an issue brief from the Pew Charitable Trusts.

During the COVID-19 pandemic, telehealth proved to be a successful care modality for delivering opioid use disorder treatment to individuals across the country. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services (SAMHSA) lifted their restrictions and allowed buprenorphine prescribers to initiate medication treatment via telehealth without requiring an in-person visit first.

However, these regulations are temporary and are set to expire once the public health emergency ends. In order to ensure access to virtual opioid use disorder treatment, state Medicaid agencies and policymakers should make these and other telehealth regulations permanent, Pew said.

Legislatures should require public and private payers to reimburse providers for all opioid use disorder treatment services delivered via telehealth, including clinical assessments, prescriptions, medication management, and counseling sessions.

Additionally, ensuring reimbursement for a variety of providers — including physicians, nurse practitioners, physician assistants, and mental health professionals — could help solidify the virtual treatment process. 

According to Pew, states that offered coverage for buprenorphine prescribing via telehealth saw positive patient outcomes that were similar to in-person services.

Policymakers should also establish payment parity between telehealth and in-person opioid use disorder treatment services under public and private payers alike.

“Without assurances of sufficient reimbursement rates, providers may be unwilling to invest in telehealth infrastructure for their practices, or they may find it infeasible to increase the use of telehealth for OUD treatment,” researchers wrote in the brief.

Medicaid programs can ensure reimbursement parity for telehealth services without submitting a plan amendment to the Centers for Medicare and Medicaid Services (CMS). Thirty-eight states and Washington D.C. have established payment parity for certain telehealth services, but not all programs include opioid use disorder services in their provisions.

Originating-site restrictions must also be addressed, Pew researchers said. Some states allow patients to use telehealth but only from certain clinics that can serve as an originating site. By expanding the list of eligible originating sites to include the patient’s home, policymakers could make accessing virtual care more convenient for individuals.

Medicare currently allows individuals to receive telehealth-based opioid use disorder treatment from their homes, according to the brief. Past studies have shown that patients can initiate buprenorphine safely and successfully while remaining in their homes. In addition, patients seemed to prefer receiving treatment from home.

Further, Medicaid programs should make audio-only telehealth policies permanent to facilitate access to virtual care, Pew researchers recommended. Audio-only coverage is set to expire when the public health emergency ends.

Ensuring that providers receive reimbursement for audio-only opioid use disorder services may help address care disparities and benefit underserved communities that tend to use the care modality most often, including Black and Hispanic populations, individuals with limited English proficiency, and communities with inadequate broadband access.

At least 15 Medicaid programs offer reimbursement for audio-only telehealth as of February, but some states only provide coverage for certain services, the brief noted.

Finally, Pew researchers recommended that policymakers allow correctional settings to offer telehealth-based opioid treatment.

Jails and prisons typically allow incarcerated individuals to receive healthcare via telehealth but the option to receive virtual opioid use disorder treatment is far less common, the brief stated. If states allocated funding to these institutions, they could invest in the necessary telehealth resources to establish virtual opioid treatment services.

A few correctional facilities, including one in Minnesota and one in Massachusetts, currently offer buprenorphine treatment, counseling sessions, and clinical assessments through telehealth.

Even with these policy changes, states may face additional barriers to offering virtual opioid treatment services including a lack of funding for infrastructure and poor broadband access.

Pew researchers suggested that states consider partnering with the National Consortium of Telehealth Resource Centers to receive assistance with launching a telehealth program.

Additionally, state and local governments can leverage funding from the American Rescue Plan Act to invest in expanding internet access to communities that need it.