US Codex
Bill
Notes

To amend title XVIII of the Social Security Act to expand access to telehealth services relating to substance use disorder treatment, and for other purposes.

H.R. 5837 · 117th Congress · Nov 3, 2021 · Lineage

A BILL

Section 1 Telehealth for substance use disorder treatment under Medicare

(a)
Telehealth for substance use disorder treatment—
(1)
Substance use disorder services furnished through telehealth under Medicare— Section 1834(m)(7)(A) of the Social Security Act (42 U.S.C. 1395m(m)(7)(A)) is amended by adding at the end the following: “With respect to telehealth services described in the preceding sentence that are furnished on or after January 1, 2020, nothing shall require an initial in-person medical evaluation by a physician or practitioner prior to the furnishing of such services through audio or telephone only technologies.”.
(2)
Controlled substances dispensed by means of the internet— Section 309(e)(2) of the Controlled Substances Act (21 U.S.C. 829(e)(2)) is amended—
(A)
in subparagraph (A)(i)—
(i)
by striking “at least 1 in-person medical evaluation” and inserting the following:

“(I) 1 in-person medical evaluation”

(ii)
by adding at the end the following:

“(II) for purposes of prescribing a controlled substance in schedule III or IV, 1 telehealth evaluation; or”

(B)
by adding at the end the following:

“(D)

“(i) The term telehealth evaluation means a medical evaluation that is conducted in accordance with applicable Federal and State laws by a practitioner (other than a pharmacist) who is at a location remote from the patient and is communicating with the patient using a telecommunications system referred to in section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) that includes, at a minimum—

“(I) audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site practitioner; or

“(II) audio-only for the prescription of a partial opioid agonist for opioid use disorder if video services are unavailable to the patient, due to lack of availability of such technology or lack of adequate broadband access, as determined by the practitioner providing telehealth services and a two-way video telehealth appointment for an in-person medical evaluation or telehealth evaluation that utilizes both audio and visual capabilities is required within 10 days of the audio-only prescription.

“(ii) Nothing in clause (i) shall be construed to imply that 1 telehealth evaluation demonstrates that a prescription has been issued for a legitimate medical purpose within the usual course of professional practice.

“(iii) A practitioner who prescribes the drugs or combination of drugs that are covered under section 303(g)(2)(C) using the authority under subparagraph (A)(i)(II) of this paragraph shall adhere to nationally recognized evidence-based guidelines for the treatment of patients with opioid use disorders and a diversion control plan, as those terms are defined in section 8.2 of title 42, Code of Federal Regulations, as in effect on the date of enactment of this subparagraph.”

(b)
Task force—
(1)
In general— Not later than 30 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish an interagency task force to collect and assess data relating to—
(A)
utilization rates of partial opioid agonist medication prescriptions for opioid use disorder furnished through telehealth based on data from the Centers for Medicare and Medicaid Services deidentified claims data, de­i­den­ti­fied private payer claims data if possible, and state prescription drug monitoring program data if possible (collectively, referred to as “Data Sources”);
(B)
opioid-related overdose rates in counties with annual rates of such prescriptions furnished in-person that are higher than the national average annual rate of such in-person prescriptions, opioid-related overdose rates in counties with less than 100 of such prescriptions furnished through telehealth annually, and opioid-related overdose rates in counties with less than 100 of such prescriptions furnished in-person annually, in each case based on the Data Sources;
(C)
emergency department admissions and readmission rates of counties described in subparagraph (B);
(D)
the cost of care to the Federal Government for such prescriptions furnished through audio-only and audio-visual telehealth, including if value-based purchasing leads to greater access to care if possible, lower diversion rates, and overall improved patient outcomes that are defined by the Secretary;
(E)
patient satisfaction surveys developed by the Secretary and in consultation stakeholder groups, such as patient or provider groups;
(F)
provider satisfaction survey developed by the Secretary and in consultation with provider groups; and
(G)
the number of practitioners furnishing such prescriptions through telehealth to 275 patients or more at any one time, including the location of each such practitioner that can be identified by ZIP code and whether each such practitioner is practicing telehealth across state lines.
(2)
Report— Not later than 180 days after the date of the enactment of this Act, and every 180 days thereafter, the Secretary shall make available on a public website of the Department of Health and Human Services and submit to the Committees on Energy and Commerce and Ways and Means of the House of Representatives and the Committees on Finance and Health, Education, Labor, and Pensions of the Senate a report that summarized the data described under paragraph (1) for the most recent 180-day period.
(3)
Guidance— The Secretary of Health and Human Services may issue guidance to providers to assist in the treatment of patients based on the data described under paragraph (1) for the most recent 180-day period.