Why Congress’s Opioid Effort is a Major Step Forward for Telehealth Reimbursement

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Over the past several weeks, the House of Representatives passed 58 opioid-related bills. The Senate is in the midst of considering their own legislation. The intent of congressional leaders in both chambers is to reconcile these legislative packages and send a final bill to the President this year. This effort is key to solving a major national problem and demonstrates that Congress can come together to support people, families and communities in need.

It also happens to be a significant step for Medicare reimbursement of telehealth. Telehealth supporters have long tried to overturn outdated statutory language that requires Medicare beneficiaries who are enrolled in traditional fee-for-service (FFS) to be in specific institutional sites in rural areas for their providers to qualify for Medicare coverage. About 80 percent of Medicare beneficiaries live in 1,200 metropolitan counties that are not considered “rural” under HHS’ definition, and making people go to a clinic or hospital to receive telehealth services defeats the purpose of the technology.

Our challenge as advocates has been assumptions by the Congressional Budget Office (CBO) that increasing access to telehealth for seniors will increase utilization without a subsequent decrease in utilization of other forms of care. In other words, they think people will use telehealth and also go to the doctor in person, thereby increasing costs. Studies showing that telehealth substitutes for in-person care, reduces re-admissions and increases preventive care have not convinced them, nor have the major investments that capitated insurers have made in telehealth services.

The opioid effort in Congress has changed the course of this debate. As a result of the dire need for behavioral health services to help mitigate the crisis, both the House and Senate have moved bills to lift telehealth restrictions in Medicare to enable more mental health and substance abuse providers to see patients via telehealth, and thereby expand access to care. The eTREAT Act (S. 2901) in the Senate would entirely lift Medicare’s originating site restrictions on reimbursement for patients suffering from substance use disorder (SUD). The Access to Telehealth Services for Opioid Disorders Act (H.R. 5603) in the House would give the Secretary of HHS authority to waive telehealth restrictions for opioid abuse disorder.

These bills, led by a powerful group of bipartisan lawmakers, have cracked the CBO code. They demonstrate what telehealth advocates have been trying for years to convey – allowing telehealth coverage in Medicare will not significantly impact the federal budget. According to CBO, the House version would cost a mere $11 million over 10 years. The Senate bill, which entirely lifts the restrictions, is only $14 million. That’s out of a program that will spend as much as $10 trillion over the same time period.

The relatively small price tag and bi-partisan support of these bills sets the stage for Congress to consider future legislation that would remove even more barriers to telehealth, and could pave the way for originating site restrictions to be lifted for all patients. In the meantime, Medicare patients with substance abuse disorders will be able to access care remotely. This is a huge step forward.