H.R. 5603 — what changed

changed This Act may be cited as the “Access to Telehealth Services for Opioid Substance Use Disorders Act”.

Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended—

changed “(7) Authority not to waive apply certain requirements in the case of certain treatment of opioid substance use disorder or co-occurring mental health disorder

changed “(A) In general—For purposes of payment under this subsection, in the case of telehealth services described in subparagraph (C) furnished on or after January 1, 2019, 2020, to an eligible beneficiary (as defined in subparagraph (F)(i)) (F)) for the treatment of an opioid a substance use disorder or a mental health disorder that is co-occurring with an opioid a substance use disorder, the Secretary may waive is authorized to, through rulemaking, not apply any of the requirements described in subparagraph (B) if the conditions described in clauses (i), (ii), and (iii) of subparagraph (D) are met with respect to such waiver.(B).

changed “(B) Requirements described—For purposes of this paragraph, the requirements described in this subparagraph include—are any of the following:

changed “(i) requirements relating to qualifications Qualifications for an originating site under paragraph (4)(C)(ii);(4)(C)(ii).

changed “(ii) geographic Geographic limitations under paragraph (4)(C)(i) (other than applicable State law requirements, including State licensure requirements); and(4)(C)(i).

changed “(iii) any limitation on the use “(C) Telehealth services described—For purposes of store-and-forward technologies this paragraph, the telehealth services described in paragraph (1).this subparagraph are services that are both telehealth services and identified by the Secretary, through rulemaking, as services that are the most commonly furnished (as defined by the Secretary) under this part to individuals diagnosed with a substance use disorder or a mental health disorder that is co-occurring with a substance use disorder.

changed “(C) Identification “(D) Clarification—Nothing in this paragraph shall be construed as limiting or otherwise affecting the authority of part B codes for application the Secretary to limit or eliminate the non-application pursuant to this paragraph of waiversany of the requirements under subparagraph (B).

changed “(i) In general—Not later than 6 months after the date of the enactment “(E) Treatment of this paragraph, the Secretary originating site facility fee—No facility fee shall review evidence related to codes under this part for telehealth services for the treatment of substance abuse and behavioral health that have been approved by the Centers for Medicare & Medicaid Services as part of the process established be paid under paragraph (4)(F)(ii) for purposes of determining the codes (2)(B) to an originating site with respect to a telehealth service described in subparagraph (B) for which a waiver applied payment is made under this paragraph would meet one or more subsection by reason of the conditions non-application of a requirement described in subparagraph (B). In carrying out this clause, particular priority should be given to reviewing evidence related (B) pursuant to codes this paragraph if payment for behavioral health services that such service would not otherwise be appropriate to provide to individuals receiving treatment from an opioid agonist treatment practitioner.permitted under this subsection if such requirement were applied.

changed “(ii) Annual review process—The Secretary shall review evidence pertaining to substance abuse and behavioral health codes as part “(F) Eligible beneficiary defined—For purposes of this paragraph, the annual process under paragraph (4)(F)(ii) to determine if a waiver may be granted.term “eligible beneficiary” means an individual who—

changed “(D) Conditions “(i) is entitled to, or enrolled for, benefits under part A and enrolled for waiver—For purposes of subparagraph (A), the conditions described in benefits under this subparagraph, with respect to a waiver of any requirement described in subparagraph (B), are each of the following:part;

changed “(i) The Secretary determines that the application of the waiver is expected to—“(ii) has a diagnosis for a substance use disorder; and

changed “(I) reduce spending under this title without reducing “(iii) meets such other criteria as the quality of care;Secretary determines appropriate.

changed “(II) improve “(G) Report—Not later than 5 years after the quality date of care without increasing spending; orthe enactment of this paragraph, the Secretary shall submit to Congress a report on the impact of any non-application under this paragraph of any of the requirements described in subparagraph (B) on

changed “(III) increase access to behavioral “(i) the utilization of health and care services related to substance use disorder, such as behavioral health services for individuals with opioid use disorders.and emergency department visits; and

changed “(ii) The Chief Actuary of the Centers for Medicare & Medicaid Services certifies that the condition described in clause (i) or (iii) is met.health outcomes related to substance use disorder, such as substance use overdose deaths.

changed “(iii) The “(H) Funding—For purposes of carrying out this paragraph, in addition to funds otherwise available, the Secretary determines that such waiver would not deny or limit shall provide for the coverage or provision of benefits transfer, from the Federal Supplementary Medical Insurance Trust Fund under this title section 1841, of $3,000,000 to the Centers for individuals.Medicare & Medicaid Services Program Management Account to remain available until expended.

changed “(E) Treatment “(8) Rule of originating site facility fee—No facility fee shall be paid under paragraph (2)(B) to an originating site with respect to a telehealth service for which payment is made under construction—Nothing in this subsection by reason of a waiver under this paragraph if payment for such service would not may be permitted construed as waiving requirements under this subsection without such waiver.title to comply with applicable State law, including State licensure requirements.”

removed “(F) Definitions—For purposes of this paragraph:

removed “(i) Eligible beneficiary—The term “eligible beneficiary” means an individual who—

removed “(I) is entitled to benefits under part A and enrolled for benefits under this part;

removed “(II) is not enrolled in a Medicare Advantage plan under part C;

removed “(III) has a diagnosis for an opioid use disorder; and

removed “(IV) meets such other criteria as the Secretary determines appropriate.

removed “(ii) Opioid agonist treatment practitioner—The term “opioid agonist treatment practitioner” means a practitioner who—

removed “(I) is enrolled under section 1866(j); and

removed “(II) is authorized to prescribe or dispense opioid agonist treatment medication for maintenance or detoxification treatment pursuant to a waiver under section 303(g)(2) of the Controlled Substances Act.

removed “(G) Report—Not later than 5 years after the date of the enactment of this paragraph, the Secretary shall submit to Congress a report on the impact of any waivers granted under this paragraph on—

removed “(i) any change in utilization rates for behavioral health services for opioid use disorders;

removed “(ii) any change in rates or average length of time of retention in treatment for opioid use disorders;

removed “(iii) any change in emergency department visits related to opioid overdoses; and

removed “(iv) any change in overdose deaths related to opioids abuse.

removed “(H) Funding—For purposes of carrying out this paragraph, in addition to funds otherwise appropriated, the Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841, of $2,000,000 to the Centers for Medicare & Medicaid Services Program Management Account.”