Four months after the United States began to feel the effects of COVID-19, U.S. Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI) introduced the Telehealth Response for E-Prescribing Addiction Therapy Services (“TREATS”) Act. During the pandemic, policymakers and insurers have strongly embraced telehealth, or the remote provision of health care services using technology, including live videoconferences, phone calls, and sophisticated online portals, to exchange information for the diagnosis, treatment, and prevention of diseases.
Previously, maintaining patient privacy and health information in compliance with the Health Insurance Portability and Accountability Act (“HIPAA”) limited the use of telehealth. These requirements made the application of telehealth for substance use disorder treatment with medications a very rare occurrence. Now that we must socially distance and keep our urgent care centers and hospitals as accessible as possible to COVID-19 patients, telehealth has been a saving grace. Based on waiver authority by the Department of Health and Human Services during the COVID-19 public health emergency, “beneficiaries in any geographic area can receive telehealth services; patients’ homes can qualify as an “originating site” from which they can access telehealth visits; telehealth visits can be delivered via smartphone with real-time audio/video interactive capabilities; and providers of telehealth services are no longer required to have treated the beneficiary in the last three years.” While these waivers provide a reprieve, they are temporary and will expire at the conclusion of the public health emergency; the TREATS Act looks to provide a much-needed solution to that scenario.
This proposed bill would convert the recent telehealth flexibilities enacted into permanent waivers and may help address longstanding issues like the overdose epidemic. As Senator Portman states, “…the increase in overdoses we’re seeing only increases the need for additional flexibility to help those suffering from addiction.” The permanency of these waivers would build upon the recent easing of regulatory restrictions for accessing care, treatment, and services for substance use disorder both during the pandemic and following it.
Per these temporary waivers, teleconferences can serve as substitute for the previous requirement of a prior in-person visit before being prescribed medication-based treatment and other necessary drugs, and doctors can bill Medicare and Medicaid for audio-only telehealth services. Additionally, the Substance Abuse and Mental Health Services Administrations (SAMHSA) and the Drug Enforcement Agency (DEA) made three major modifications to long-standing rules regarding buprenorphine and methadone, two medications that have been shown to be at least twice as effective at helping people sustain their recovery from opioid use disorder as therapies that do not include medications. The first was that opioid treatment programs (commonly known as methadone clinics) could allow most patients to take home several days’ or weeks’ worth of medication, packaged in individual doses. Next, patients could be started on buprenorphine following a teleconference or phone call; however, unlike buprenorphine, before being prescribed methadone, a thorough in-person physical exam, not just a teleconference or phone call, is still required. And finally, after receiving the appropriate introductory screening for each anti-addiction drug, it is now acceptable that both buprenorphine and methadone patients can receive follow-up counseling and medication management via telehealth technology.
The most impactful effects of these waivers are that they have helped patients maintain access to care safely while at home, reduced exposure to the virus, and increased access to care for individuals who did not otherwise have access to in-person treatment. For example, Hazelden Betty Ford in Minnesota did not have a virtual care system in place before the pandemic, but their quick launch of a program called RecoveryGo now allows for counseling and treatment online. Virtual group attendance rates have been higher than in-person attendance of facility-based groups before the pandemic. This difference is especially stark for individuals in rural communities and beyond who, prior to the public health emergency and relaxed restrictions, were required to travel great distances to inconvenient clinics and wait in long lines, often on a daily basis, in order to access medication. These temporary waivers should become permanent, as rolling back these helpful measures to their previous and antiquated restrictions once the public health emergency is deemed over will eliminate the positive steps taken to assist all disadvantaged groups, including persons who are disabled or elderly, but especially people with substance use disorder. The pandemic may wane, but substance use disorders are chronic conditions, and telehealth sessions have been a lifeline to people who are in treatment and wish to sustain their recovery. Several organizations, including the American Society for Addiction Medicine, believe that the TREATS Act will be a powerful tool that can help people with a chronic substance use disorder and remove unnecessary barriers that promote stigma and marginalization toward people with addiction.