States are turning to telehealth to minimize direct contact between patients, providers, and other staff during the COVID-19 pandemic. For opioid use disorder (OUD) treatment, this shift represents a significant departure from how these services have been historically delivered and requires rapid organizational changes.
State policymakers are quickly restructuring OUD treatment, including the administration of medications for opioid use disorder (MOUD) that include buprenorphine and methadone, and addressing barriers to telehealth for OUD by coordinating with providers to streamline processes and adapt to a rapidly changing landscape in accordance with federal guidance.
State Strategies
Supporting providers to increase telehealth access. Recent guidance from the Drug Enforcement Agency (DEA) waived the need for an in-person evaluation in order for a provider to prescribe buprenorphine for the first time, underscoring the urgency to gain capacity for telehealth services by OUD providers.
- The Maryland Health Care Commission has developed a Telehealth Virtual Resource Center to encourage the adoption and use of telehealth. The resource center provides technology tips for providers and includes a telehealth readiness assessment for ambulatory services to improve the delivery of telehealth services.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) temporarily opened the door for providers to prescribe buprenorphine for new patients via telephone, with the DEA following suit for audio only calls, provided that the telephone call aligns with adequate levels of care. Tennessee, for example, is now permitting telephonic sessions in a TennCare (Medicaid) enrollee’s home when that member has concerns about COVID-19.
- Many states are following suit. The New Jersey Division of Medical Assistance and Health Services (DMAHS) has also permitted providers to utilize telephonic or audio-only technology for the delivery of telehealth service, as long as the technology meets the state’s standard of care. New Jersey also removed the face-to-face requirement for federally qualified health centers, enabling them to bill at the full rates for a virtual encounter when utilizing telephonic technology to deliver telehealth services.
- In an effort to increase utilization of telehealth services, the Washington Health Care Authority has purchased a limited number of Zoom licenses for providers to utilize to administer telehealth services. The licenses will be prioritized for providers who have greatest need, including providers who prescribe MOUD.
- While Zoom can provide Health Insurance Portability and Accountability Act (HIPAA) compliant products (with an executed Business Associate Agreement), states should be aware that Zoom has experienced a drastic increase in usage, which has exposed privacy issues within the platform’s design. US Sen. Richard Blumenthal of Connecticut recently sent a letter to Zoom, outlining these privacy concerns.
Payment: States are quickly updating billing procedures and reimbursement rates to support their transition to telehealth.
- Rhode Island provides in-depth guidance on Medicaid billing for telehealth fee-for-service and managed care providers, including behavioral health providers, to streamline reimbursement. The resource outlines billing codes to be utilized for service delivery by physicians, nurse practitioners, counselors, and peers.
- Kentucky’s Cabinet for Health and Family Services for Medicaid has also provided billing guidance to providers, highlighting that targeted case management, peer support services, and community services are now eligible for delivery via telehealth.
- Washington has ensured payment parity for telehealth services and in-person services, increasing behavioral health telehealth rates to match those for in-person services.
What Happens to Telehealth after the Pandemic?
The trajectory of policy change over the course of the pandemic has been to ease restrictions and remove barriers to the provision of OUD services via telehealth. The long-term implications remain to be seen, but the shift toward telehealth represents a significant clinical practice change, one that highlights longstanding concerns about the quality of care delivered via telehealth – particularly safety and confidentiality concerns around prescribing MOUD without urine drug screens and physical exams. Ultimately, in order to maintain patient safety while continuing to use telehealth models, states may need to consider how to address limiting telehealth services while retaining patients.
Providing OUD treatment through telehealth has fiscal effects as well. Incentivizing and easing telehealth now via strategies that raise reimbursement rates for telehealth services to create parity or add new services altogether will be reflected in Medicaid budgets downstream – especially if those services continue beyond this emergency. States may need to adapt regulations, reconsider reimbursement rates for OUD services and capitation, and potentially amend managed care contracts to reflect significant shifts in service delivery.
The COVID-19 pandemic has forced states and providers into wildly new territory in order to ensure that patients continue to have access to life-saving OUD services. While states have adapted extraordinarily quickly and are developing creative solutions to ensure continued access to OUD treatment, the removal of barriers during this emergency may have important ramifications on the future of telehealth policy.
