I 

115TH CONGRESS 

2D SESSION H. R. 5603 

To amend title XVIII of the Social Security Act to provide the Secretary 

of Health and Human Services authority to waive certain Medicare 

telehealth requirements in the case of certain treatment of an opioid 

use disorder or co-occurring mental health disorder. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 24, 2018 

Ms. MATSUI (for herself and Mr. CA ́RDENAS) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

the Secretary of Health and Human Services authority 

to waive certain Medicare telehealth requirements in the 

case of certain treatment of an opioid use disorder or 

co-occurring mental health disorder. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Access to Telehealth 

5 Services for Opioid Use Disorders Act’’. 


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1 SEC. 2. AUTHORITY TO WAIVE CERTAIN MEDICARE TELE2 HEALTH REQUIREMENTS IN THE CASE OF 

3 CERTAIN TREATMENT OF AN OPIOID USE DIS4 ORDER OR CO-OCCURRING MENTAL HEALTH 

5 DISORDER. 

6 Section 1834(m) of the Social Security Act (42 

7 U.S.C. 1395m(m)) is amended— 

8 (1) in paragraph (2)(B)(i), by inserting ‘‘and 

9 paragraph (7)(E)’’ after ‘‘subject to clause (ii)’’; and 

10 (2) by adding at the end the following new 

11 paragraph: 

12 ‘‘(7) AUTHORITY TO WAIVE CERTAIN REQUIRE13 MENTS IN THE CASE OF CERTAIN TREATMENT OF

14 OPIOID USE DISORDER OR CO-OCCURRING MENTAL

15 HEALTH DISORDER.— 

16 ‘‘(A) IN GENERAL.—For purposes of pay17 ment under this subsection, in the case of tele18 health services furnished on or after January 1, 

19 2019, to an eligible beneficiary (as defined in 

20 subparagraph (F)(i)) for the treatment of an 

21 opioid use disorder or a mental health disorder 

22 that is co-occurring with an opioid use disorder, 

23 the Secretary may waive any of the require24 ments described in subparagraph (B) if the con25 ditions described in clauses (i), (ii), and (iii) of 


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1 subparagraph (D) are met with respect to such 

2 waiver. 

3 ‘‘(B) REQUIREMENTS DESCRIBED.—For 

4 purposes of this paragraph, the requirements 

5 described in this subparagraph include— 

6 ‘‘(i) requirements relating to qualifica7 tions for an originating site under para8 graph (4)(C)(ii); 

9 ‘‘(ii) geographic limitations under 

10 paragraph (4)(C)(i) (other than applicable 

11 State law requirements, including State li12 censure requirements); and 

13 ‘‘(iii) any limitation on the use of 

14 store-and-forward technologies described in 

15 paragraph (1). 

16 ‘‘(C) IDENTIFICATION OF PART B CODES

17 FOR APPLICATION OF WAIVERS.— 

18 ‘‘(i) IN GENERAL.—Not later than 6 

19 months after the date of the enactment of 

20 this paragraph, the Secretary shall review 

21 evidence related to codes under this part 

22 for telehealth services for the treatment of 

23 substance abuse and behavioral health that 

24 have been approved by the Centers for 

25 Medicare & Medicaid Services as part of 


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1 the process established under paragraph 

2 (4)(F)(ii) for purposes of determining the 

3 codes for which a waiver applied under this 

4 paragraph would meet one or more of the 

5 conditions described in subparagraph (B). 

6 In carrying out this clause, particular pri7 ority should be given to reviewing evidence 

8 related to codes for behavioral health serv9 ices that would be appropriate to provide 

10 to individuals receiving treatment from an 

11 opioid agonist treatment practitioner. 

12 ‘‘(ii) ANNUAL REVIEW PROCESS.— 

13 The Secretary shall review evidence per14 taining to substance abuse and behavioral 

15 health codes as part of the annual process 

16 under paragraph (4)(F)(ii) to determine if 

17 a waiver may be granted. 

18 ‘‘(D) CONDITIONS FOR WAIVER.—For pur19 poses of subparagraph (A), the conditions de20 scribed in this subparagraph, with respect to a 

21 waiver of any requirement described in subpara22 graph (B), are each of the following: 

23 ‘‘(i) The Secretary determines that 

24 the application of the waiver is expected 

25 to— 


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1 ‘‘(I) reduce spending under this 

2 title without reducing the quality of 

3 care; 

4 ‘‘(II) improve the quality of care 

5 without increasing spending; or 

6 ‘‘(III) increase access to behav7 ioral health and substance use services 

8 for individuals with opioid use dis9 orders. 

10 ‘‘(ii) The Chief Actuary of the Centers 

11 for Medicare & Medicaid Services certifies 

12 that the condition described in clause (i) or 

13 (iii) is met. 

14 ‘‘(iii) The Secretary determines that 

15 such waiver would not deny or limit the 

16 coverage or provision of benefits under this 

17 title for individuals. 

18 ‘‘(E) TREATMENT OF ORIGINATING SITE

19 FACILITY FEE.—No facility fee shall be paid 

20 under paragraph (2)(B) to an originating site 

21 with respect to a telehealth service for which 

22 payment is made under this subsection by rea23 son of a waiver under this paragraph if pay24 ment for such service would not be permitted 

25 under this subsection without such waiver. 


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1 ‘‘(F) DEFINITIONS.—For purposes of this 

2 paragraph: 

3 ‘‘(i) ELIGIBLE BENEFICIARY.—The 

4 term ‘eligible beneficiary’ means an indi5 vidual who— 

6 ‘‘(I) is entitled to benefits under 

7 part A and enrolled for benefits under 

8 this part; 

9 ‘‘(II) is not enrolled in a Medi10 care Advantage plan under part C; 

11 ‘‘(III) has a diagnosis for an 

12 opioid use disorder; and 

13 ‘‘(IV) meets such other criteria 

14 as the Secretary determines appro15 priate. 

16 ‘‘(ii) OPIOID AGONIST TREATMENT

17 PRACTITIONER.—The term ‘opioid agonist 

18 treatment practitioner’ means a practi19 tioner who— 

20 ‘‘(I) is enrolled under section 

21 1866(j); and 

22 ‘‘(II) is authorized to prescribe or 

23 dispense opioid agonist treatment 

24 medication for maintenance or detoxi25 fication treatment pursuant to a waivVerDate Sep 11 2014 05:50 Apr 26, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5603.IH H5603

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1 er under section 303(g)(2) of the Con2 trolled Substances Act. 

3 ‘‘(G) REPORT.—Not later than 5 years 

4 after the date of the enactment of this para5 graph, the Secretary shall submit to Congress a 

6 report on the impact of any waivers granted 

7 under this paragraph on— 

8 ‘‘(i) any change in utilization rates for 

9 behavioral health services for opioid use 

10 disorders; 

11 ‘‘(ii) any change in rates or average 

12 length of time of retention in treatment for 

13 opioid use disorders; 

14 ‘‘(iii) any change in emergency de15 partment visits related to opioid overdoses; 

16 and 

17 ‘‘(iv) any change in overdose deaths 

18 related to opioids abuse. 

19 ‘‘(H) FUNDING.—For purposes of carrying 

20 out this paragraph, in addition to funds other21 wise appropriated, the Secretary shall provide 

22 for the transfer, from the Federal Supple23 mentary Medical Insurance Trust Fund under 

24 section 1841, of $2,000,000 to the Centers for 


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1 Medicare & Medicaid Services Program Man2 agement Account.’’. 

Æ 


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