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.
Bill: H.R.5837 | Sponsor: Rep. Curtis, John R. (R-UT)
Policy area: Health

Summary:
This bill modifies requirements relating to coverage of certain telehealth services under Medicare. Specifically, the bill permanently allows telehealth services for substance-use disorders and mental health disorders to be provided via audio-only technology and without an initial in-person evaluation.
Schedule III or IV controlled substances may also be prescribed online if a practitioner has conducted a telehealth evaluation with video; certain opioid agonists may be prescribed via audio-only technology if the beneficiary initially lacks access to video technology but receives a follow-up evaluation via video within 10 days.
The Department of Health and Human Services must establish an interagency task force to study the utilization and effect of opioid agonist prescriptions that are issued via telehealth.

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.

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

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: ``at least--
                                    ``(I) 1 in-person medical 
                                evaluation''; and
                            (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''; 
                                and
                    (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.
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