New Bill Would Expand Telehealth Options for MAT, Substance Abuse Programs

A new bill before Congress aims to permanently allow healthcare providers to use telehealth in medication-assisted treatment (MAT) programs for substance abuse and provide Medicare coverage for audio-only phone calls.

The two policy changes are part of the Comprehensive Addiction and Recovery Act (CARA) 2.0 bill introduced last week by Senators Rob Portman (R-OH), Sheldon Whitehouse (D-RI) and Amy Klobuchar (D-MN). The bill increases funding authorization levels established in the original CARA legislation in 2016 and adds connected health measures to tackle the growing opioid abuse crisis.

“In recent years we have made real progress in fighting the scourge of addiction thanks to resources from the bipartisan CARA law, in addition to other bipartisan efforts in Congress,” Portman said in a press release. “However, the COVID-19 pandemic has created unprecedented challenges and we are now seeing a heartbreaking surge in overdose deaths. That is why we must redouble our efforts to combat addiction and help those who are suffering during this crisis.”

Specifically, the bill would allow providers to use telehealth to prescribe medications in MAT therapy without an in-person exam. Providers have long been hamstrung by this restriction, which was put in place by the Ryan Haight Act of 2008. That bill called for a special registration process, managed by the US Drug Enforcement Agency, for providers who want to use telehealth, but that registration process has never been created despite intense lobbying.

Recently, more than 80 organizations, ranging from telehealth health providers and health systems to the American Telemedicine Association and America’s Health Insurance Plans, signed a letter asking the DEA to establish the registration process.

“Our experience during COVID-19 has demonstrated the value of increased access to telemedicine to enable all qualified providers, including Community Mental Health Centers and addiction treatment facilities, to prescribe Medication-Assisted Treatment (MAT) to patients with Opioid Use Disorder (OUD),” the letter, penned by the Alliance for Connected Care, states.

The Ryan Haight Act laid the groundwork – reinforced by the SUPPORT Act – for a special registration that would allow providers to prescribe, deliver, distribute and dispense a controlled substance to patients without the requirement for an in-person examination. The idea behind the registration is to allow providers to use connected health platforms – including MAT therapy therapy - to treat patients living with substance abuse issue who might not have easy access to in-person treatment.

The registration would come with certain conditions:

• Providers must demonstrate a legitimate need for the special registration;
• They must be registered to deliver, distribute, dispense or prescribe controlled substances in the state where the patient is located; and
• They must maintain compliance with federal and state laws when delivering, distributing, dispensing and prescribing a controlled substance.

In addition, the CARA 2.0 bill would allow providers to use audio-only telehealth platforms in substance abuse treatment, as long as they’d first met in person with the patient.

Other policy changes included in CARA 2.0 include new research into non-opioid pan management alternatives, such as digital therapeutics; the establishment of a pilot program to study the value of mobile methadone clinics – which could include mHealth and telemedicine – in underserved parts of the country.

In addition, the bill would set aside $200 million annually to build support programs for those in recovery, including programs in rural and underserved areas that make use of telehealth to improve access.  It also would remove limits on the number of patients to whom providers can prescribe medications in MAT therapy, opening the door for providers to expand their treatment reach through telehealth.