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Bill would expand Medicare telehealth coverage for substance abuse

Expansion in coverage is aimed at providing easier access to care in face of opioid crisis, says Catherine Pugh.

A bill proposed in the Senate would allow Medicare to reimburse providers who conduct behavioral health consultations for substance abuse via telemedicine, an expansion of coverage that could include in-home remote telehealth sessions with Medicare beneficiaries.

The bill is limited to expanding the use of telehealth services for the treatment of opioid use disorder and other substance abuse disorders.

The Medicare program already reimburses providers for face-to-face behavioral healthcare services, including mental health services and substance abuse treatment. But the proposed legislation would increase availability of those services, backers say.

“This is a very big deal,” says Catherine Pugh, senior director of government affairs at Health IT Now, a broad-based coalition of patient groups, provider organizations, employers and payers. “Medicare has a smaller population of persons affected by opioids, but Medicare also is one of the fastest-growing areas of opioid disorders. More importantly, providers can be with patients when they need care and are experiencing a crisis.”

As individuals get older, they begin experiencing more pain, so their clinicians are feeling increasing pressure to ensure access to pain relief treatment, meanwhile controlling the amount of opioids prescribed toward that end, Pugh adds.

The bipartisan proposed legislation, entitled, “Expanding Telehealth Response to Ensure Addiction Treatment Act,” also called the eTREAT Act, is sponsored by senators John Thune (R-S.D.), Mark Warner (D-Va.), Ben Cardin (D-Md.), John Cornyn (R-Texas), Brian Schatz (D-Hawaii) and Roger Wicker (R-Mo.).

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Medicaid and other health insurers often follow Medicare’s lead on treatment coverage, so if Medicare starts to reimburse providers for telehealth consultations for substance abuse treatment, other insurers may do the same, Pugh notes.

Further, Medicare currently only offers telehealth reimbursement within federally designated rural areas; however, the proposed bill would remove such geographic restrictions.

Joel White, executive director at Health IT Now, believes time is of the essence to expand use of telehealth to accelerate addiction treatment. “We know that telehealth can bridge the gap of distance and stigma by allowing beneficiaries to receive care when and where they need it, but inflexible bureaucratic restrictions are putting that possibility out of reach for too many,” he says. “This bipartisan legislation will right that wrong and expand access to treatment via telehealth for Medicare beneficiaries struggling under the weight of addiction.”

The bill calls for existing restrictions on reimbursement for behavioral health consultations to be rescinded on January 1.

Text of the proposed legislation is available here.

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