[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5603 Introduced in House (IH)]

<DOC>






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. Cardenas) 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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Access to Telehealth Services for 
Opioid Use Disorders Act''.

SEC. 2. AUTHORITY TO WAIVE CERTAIN MEDICARE TELEHEALTH REQUIREMENTS IN 
              THE CASE OF CERTAIN TREATMENT OF AN OPIOID USE DISORDER 
              OR CO-OCCURRING MENTAL HEALTH DISORDER.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is 
amended--
            (1) in paragraph (2)(B)(i), by inserting ``and paragraph 
        (7)(E)'' after ``subject to clause (ii)''; and
            (2) by adding at the end the following new paragraph:
            ``(7) Authority to waive certain requirements in the case 
        of certain treatment of opioid use disorder or co-occurring 
        mental health disorder.--
                    ``(A) In general.--For purposes of payment under 
                this subsection, in the case of telehealth services 
                furnished on or after January 1, 2019, to an eligible 
                beneficiary (as defined in subparagraph (F)(i)) for the 
                treatment of an opioid use disorder or a mental health 
                disorder that is co-occurring with an opioid use 
                disorder, the Secretary may waive any of the 
                requirements described in subparagraph (B) if the 
                conditions described in clauses (i), (ii), and (iii) of 
                subparagraph (D) are met with respect to such waiver.
                    ``(B) Requirements described.--For purposes of this 
                paragraph, the requirements described in this 
                subparagraph include--
                            ``(i) requirements relating to 
                        qualifications for an originating site under 
                        paragraph (4)(C)(ii);
                            ``(ii) geographic limitations under 
                        paragraph (4)(C)(i) (other than applicable 
                        State law requirements, including State 
                        licensure requirements); and
                            ``(iii) any limitation on the use of store-
                        and-forward technologies described in paragraph 
                        (1).
                    ``(C) Identification of part b codes for 
                application of waivers.--
                            ``(i) In general.--Not later than 6 months 
                        after the date of the enactment of this 
                        paragraph, the Secretary shall review evidence 
                        related to codes under this part for telehealth 
                        services for the treatment of substance abuse 
                        and behavioral health that have been approved 
                        by the Centers for Medicare & Medicaid Services 
                        as part of the process established under 
                        paragraph (4)(F)(ii) for purposes of 
                        determining the codes for which a waiver 
                        applied under this paragraph would meet one or 
                        more of the conditions described in 
                        subparagraph (B). In carrying out this clause, 
                        particular priority should be given to 
                        reviewing evidence related to codes for 
                        behavioral health services that would be 
                        appropriate to provide to individuals receiving 
                        treatment from an opioid agonist treatment 
                        practitioner.
                            ``(ii) Annual review process.--The 
                        Secretary shall review evidence pertaining to 
                        substance abuse and behavioral health codes as 
                        part of the annual process under paragraph 
                        (4)(F)(ii) to determine if a waiver may be 
                        granted.
                    ``(D) Conditions for waiver.--For purposes of 
                subparagraph (A), the conditions described in this 
                subparagraph, with respect to a waiver of any 
                requirement described in subparagraph (B), are each of 
                the following:
                            ``(i) The Secretary determines that the 
                        application of the waiver is expected to--
                                    ``(I) reduce spending under this 
                                title without reducing the quality of 
                                care;
                                    ``(II) improve the quality of care 
                                without increasing spending; or
                                    ``(III) increase access to 
                                behavioral health and substance use 
                                services for individuals with opioid 
                                use disorders.
                            ``(ii) The Chief Actuary of the Centers for 
                        Medicare & Medicaid Services certifies that the 
                        condition described in clause (i) or (iii) is 
                        met.
                            ``(iii) The Secretary determines that such 
                        waiver would not deny or limit the coverage or 
                        provision of benefits under this title for 
                        individuals.
                    ``(E) Treatment of originating site facility fee.--
                No facility fee shall be paid under paragraph (2)(B) to 
                an originating site with respect to a telehealth 
                service for which payment is made under this subsection 
                by reason of a waiver under this paragraph if payment 
                for such service would not be permitted under this 
                subsection without such waiver.
                    ``(F) Definitions.--For purposes of this paragraph:
                            ``(i) Eligible beneficiary.--The term 
                        `eligible beneficiary' means an individual 
                        who--
                                    ``(I) is entitled to benefits under 
                                part A and enrolled for benefits under 
                                this part;
                                    ``(II) is not enrolled in a 
                                Medicare Advantage plan under part C;
                                    ``(III) has a diagnosis for an 
                                opioid use disorder; and
                                    ``(IV) meets such other criteria as 
                                the Secretary determines appropriate.
                            ``(ii) Opioid agonist treatment 
                        practitioner.--The term `opioid agonist 
                        treatment practitioner' means a practitioner 
                        who--
                                    ``(I) is enrolled under section 
                                1866(j); and
                                    ``(II) is authorized to prescribe 
                                or dispense opioid agonist treatment 
                                medication for maintenance or 
                                detoxification treatment pursuant to a 
                                waiver under section 303(g)(2) of the 
                                Controlled Substances Act.
                    ``(G) Report.--Not later than 5 years after the 
                date of the enactment of this paragraph, the Secretary 
                shall submit to Congress a report on the impact of any 
                waivers granted under this paragraph on--
                            ``(i) any change in utilization rates for 
                        behavioral health services for opioid use 
                        disorders;
                            ``(ii) any change in rates or average 
                        length of time of retention in treatment for 
                        opioid use disorders;
                            ``(iii) any change in emergency department 
                        visits related to opioid overdoses; and
                            ``(iv) any change in overdose deaths 
                        related to opioids abuse.
                    ``(H) Funding.--For purposes of carrying out this 
                paragraph, in addition to funds otherwise appropriated, 
                the Secretary shall provide for the transfer, from the 
                Federal Supplementary Medical Insurance Trust Fund 
                under section 1841, of $2,000,000 to the Centers for 
                Medicare & Medicaid Services Program Management 
                Account.''.
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