Passed in October 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act and its provisions seek to tackle the opioid misuse crisis by encouraging recovery, supporting affected caregivers and families, and encouraging innovation to create long-term solutions. As Health Policy News previously reported, a particularly interesting element of the SUPPORT Act is its promotion of expanded use of telemedicine to address this need.
Below, we provide an overview of recent federal efforts to address the growing demand for recovery and substance use disorder (SUD) treatment services, as well as New York State’s resulting initiatives to promote telehealth as a viable service delivery method.
Background
In advance of the SUPPORT Act’s passage, the U.S. Department of Health and Human Services (HHS) released guidance detailing recent changes made to expand access to medication-assisted treatment (MAT)—emphasizing the efficacy of this treatment regimen for SUD recovery. HHS’s changes were aimed at ameliorating a specific barrier to MAT access: the limited number of practitioners with a Drug Addiction Treatment Act of 2000 (“DATA 2000”) waiver. This waiver allows qualified practitioners to prescribe buprenorphine to treat of opioid use disorder in settings other than federally regulated opioid treatment programs.
The HHS guidance stated that providers would be exempt from the in-person medical evaluation required to dispense controlled substances over the Internet if they were 1) registered with the Drug Enforcement Agency and 2) engaged in the practice of telemedicine. By expanding access to qualified physicians, this change allowed patients in need of MAT for whom these services were not easily accessible to continue the recovery process. Additionally, HHS released materials for practitioners’, in particular, rural practitioners, that outline how to utilize telemedicine and apply for grant funds to support the integration of telehealth into practices.
Recent State Activity
States like New York (NY) have since issued guidance promoting the use of telehealth among commercial and Medicaid insurance providers. These state-specific publications explain the importance of telehealth in building access capacity to MAT and SUD providers, and encourage payors to integrate telehealth into their benefit offerings as a way of targeting the opioid epidemic.
Additionally, NY passed the Telehealth Parity Law[1] in 2018, laying out a model for how commercial and Medicaid insurance providers can utilize and bill for telehealth services. The state released a presentation about the new parity law after its passage, which served as a primer for the public about what is required and permissible under the NY Telehealth Parity Law (including clear definitions that other states could use as examples).
Following the parity law’s enactment in February 2019, NY issued guidance detailing the additional provider types, applications, and sites included in the state’s telehealth service coverage expansion. Among these are telehealth services rendered for credentialed alcoholism and substance abuse counselors (CASACs)—with further guidance concerning the alignment of state law and Medicaid payment policy forthcoming from the New York State Office of Alcoholism and Substance Abuse Services to the Office of Addiction Services and Supports (OASAS). As other states seek to clarify compliance with state and federal law on the expansion of telehealth for SUD treatment, NY is a good model for states to look to.
As a service delivery approach that has both federal support and existing implementation guidance in other states, MAT and SUD treatment via telehealth is a compelling avenue for regulators to consider as they attempt to improve enrollee access issues. States should consider ways they can support or urge health insurance issuers to include this as a benefit through network adequacy compliance, especially when provider networks, or the dispersion of SUD/MAT providers does not support access or capacity needs in a state. In implementing telemedicine coverage for these services, states both support health insurers and help ensure that all patients in need of SUD treatments can receive them.
[1] Public Health Law (PHL) Article 29-G, Social Services Law § 367- u, and Insurance Law § 3217-h
