Payers should look to telehealth for opioid treatment, according to guidance from the Centers for Medicare & Medicaid Services that was released on June 11, 2018. The letter from the acting director of CMS guides local Medicaid agencies on methods for using technology and monitoring tools to facilitate both preventative medicine and treatment. CMS recommends a comprehensive approach to patient supervision, identification of problem behaviors, and recommendations for treatment that utilize technology to bridge care gaps.
CMS encourages Medicaid payers to evaluate telehealth as a solution for both increasing access to care and improving care coordination for patients who are high-risk or who are actively seeking treatment. These recommendations are specifically for Medicaid payers and do not apply to Medicare or Medicare Advantage plans, though the evidence for telemedicine opioid treatment applies to all demographics.
Telehealth platforms help bridge provider shortages and reduce wait times for patients who are seeking treatment, and CMS is encouraging payers to support implementation of telehealth tools to limit these gaps. Federal funding is tied to efforts to use technology for care coordination, which can be managed through telehealth at limited cost to the payer or the provider.
Telehealth is recommended as part of a Medication Assisted Treatment program when access is limited and when it is appropriate for the patient. CMS goes as far as recommending options for virtual treatment centers and utilizing remote counseling options.
The letter supports telehealth for service planning and coordination, facilitation of services, advocating for the member, and monitoring and reassessment of services. These categories offer broad support in the utilization of telemedicine for opioid addiction when clinically appropriate and within the standard of care to deliver services.
Medicaid agencies may have access to funding to support their efforts to implement these strategies. The HITECH act can match up to 90 percent of funding for activities related to health information management, and the letter from CMS indicates that these efforts potentially fall under that category. States could receive up to 90 percent match for designing and implementing programs to meet these needs and up to 75 percent funding for maintenance of the programs once they’re implemented.
EHRs were the primary drivers behind the HITECH funding, and CMS notes that many behavioral health providers lack access to EMRs. By supporting these providers with funding as well as the tools to bridge care gaps, HITECH increases access to care by offering funding to payers who can then support providers in these efforts.
There are several things taken into consideration when evaluating which agencies qualify for the match funding under the HITECH act, but at a minimum, programs should be categorized as a Section 1115 demonstration program under the Social Security Act. Section 1115 focuses on state-specific programs for improvements in Medicaid populations.
The letter also emphasized the importance of prescription drug monitoring programs (PDMPs) and recommends that these programs begin integrating with Electronic Medical Records to reduce the number of programs that facilities need to use to e-prescribe and check prescription records. Clinical workflow is important in these instances, and CMS recommends that PDMPs be integrated with Prescribe programs to take advantage of single sign on and make warnings available to providers from within the program.
While telehealth reimbursement from CMS still lags behind for Medicare patients, national steps are being taken to support states in finding ways to combat the opioid epidemic, and telehealth is being recognized at the national level. Payers are empowered through funding and support to increase access to care, utilize more providers and share best practices for implementation and maintaining these programs. To get more information about how our telehealth company can help your program, request a demo above. Our team can assist in customizing workflows and developing a program just for your use case.
For more information on the CMS Recommendations, click here: http://www.medicaid.gov/federal-policy-guidance/downloads/smd18006.pdf