Lawmakers press for audio-only telehealth extensions for prescribing opioid abuse treatments

House lawmakers are pressing for federal regulators to extend telehealth flexibilities to prescribe medication-assisted treatments to combat opioid abuse amid concerns over the “unpredictable future” of coverage for audio-only telehealth. 

Reps. Ann McLane Kuster, D-New Hampshire, and Lori Trahan, D-Massachusetts, wrote a letter late last week to the (PDF) heads of the Substance Abuse and Mental Health Services Administration (SAMSHA) and the Drug Enforcement Administration (DEA) seeking to develop long-term action on telehealth flexibilities.

“Current trends project that drug overdoses are increasing and disparities have been worsening over the last several years, with opioid-related overdose deaths reaching an all-time high in 2021,” the lawmakers wrote. 

The 2023 Physician Fee Schedule—which sets Medicare payment rates and policies for physicians—proposed by the Centers for Medicare & Medicaid Services (CMS) granted audio-only telehealth coverage for buprenorphine, a key opioid abuse treatment.

However, audio-only telehealth coverage will be reimbursed only if the DEA and SAMSHA authorize it. 

“Recognizing that payment for services is dependent on DEA and SAMSHA guidance, we encourage the agencies to release this public guidance as soon as possible and urge this guidance includes policies to increase access to treatment for [opioid use disorder] such as continued access to telehealth services for the initiation of buprenorphine,” the letter said. 

The lawmakers also want DEA and SAMSHA to consider adding telehealth flexibility as part of the public health emergency on the opioid crisis. They requested a projected timeline for creating a rule on audio-only telehealth to prescribe buprenorphine. 

Kuster and Trahan’s letter underscores the concerns some lawmakers have over the future of telehealth services that have become popular since the start of the COVID-19 pandemic. 

CMS greatly expanded the services eligible for reimbursement under telehealth at the onset of the pandemic, including audio-only telehealth that can help reach those in underserved communities. 

However, these flexibilities are expected to go away five months after the COVID-19 public health emergency ends. The emergency is expected to be extended by the Department of Health and Human Services for another 90 days later this week. 

CMS has said that Congress will need to step in to make some of the flexibilities permanent. 

The House passed legislation last month that would extend the flexibilities through December 2024 in order to give CMS more time to determine what services should be made permanent. 

Audio-only telehealth has emerged as an increasingly popular option for patients overall. A study published in July in the American Journal of the Medical Sciences found similar rates of satisfaction between video and audio-only visits.