From Healthcare Dive

The rule marks the first substantial changes to treatment and delivery standards at opioid treatment programs in more than 20 years, the government said.

Dive Brief:

• The HHS on Thursday finalized a rule that will allow opioid treatment programs to begin some medication treatment via telehealth.
• Under the rule, these providers will be able to initiate treatment with buprenorphine through audio-only or audio-visual telehealth. They can begin methadone treatment via an audio-visual platform — but not through an audio-only option due to its higher risk profile, the Substance Abuse and Mental Health Services Administration said.
• The regulation makes permanent telehealth flexibilities that began during the COVID-19 pandemic to preserve access to care and tackle a worsening opioid epidemic.

Dive Insight:

The rule marks the first substantial changes to treatment and delivery standards at opioid treatment programs in more than 20 years, SAMHSA said.

The updates — which also include expanding eligibility for patients to receive take-home doses of methadone and allowing more provider types to order medications — aim to reduce stigma and expand care access, which can be challenges to treating people with substance use disorders.

Telehealth could be a significant aid on that front, experts say. Virtual care use soared during the COVID pandemic, helped by loosened regulations that allowed patients to receive care while maintaining social distance.

Some research has shown telehealth can expand who can access mental healthcare and opioid use disorder treatment, potentially preventing overdoses. Provisional data suggests drug overdose deaths reached nearly 107,000 during the 12 months ending in August 2023, according to the Centers for Disease Control and Prevention.

“While this rule change will help anyone needing treatment, it will be particularly impactful for those in rural areas or with low income for whom reliable transportation can be a challenge, if not impossible,” Miriam Delphin-Rittmon, the HHS assistant secretary for mental health and substance use, said in a statement.

Regulators have made other changes that could improve access to substance use disorder treatment. During the pandemic, the Drug Enforcement Administration granted exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which required most practitioners to have at least one in-person evaluation before prescribing controlled substances.

The DEA and the HHS announced in the fall that they would extend pandemic-era prescribing rules through 2024. Advocates cheered the extension, arguing in-person requirements limited access, particularly for opioid use disorder care.

A feature article in The Rural Monitor looks at a program in Mississippi that provides a monthly credit for fresh produce at local markets for individuals with diet-related chronic health conditions.  The USDA Produce Prescription Program is accepting applications until February 28.

Read the full article here.

An interactive timeline from the national nonprofit KFF gives an historical view of U.S. federal policies and events that have influenced present-day health disparities.

View the timeline here.

The Centers for Medicare & Medicaid Services (CMS) released guidance for the implementation of the Office & Outpatient (O/O) Evaluation and Management (E/M) visit complexity add-on code G2211 beginning January 1, 2024. Included in the guidance are the documentation requirements for G2211, the correct use of the code and modifier 25, and patient coinsurance and deductible.

Read the full article here.

Starting January 1, 2024, Medicare began coverage and payment for Intensive Outpatient Program (IOP) services that Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) provide for people with mental health needs. An IOP is a distinct and organized outpatient program of psychiatric services provided for patients with acute mental illness including, but not limited to, conditions such as depression, schizophrenia, and substance use disorder. The Centers for Medicare & Medicaid Services (CMS) will pay for IOP services provided at the same payment rate as those paid to hospitals. Additional information on IOP services including scope of benefits, certification and plan of care requirements, payment policies, and coding and billing requirements is included in the recent CMS guidance.

Read the full article here.

The Centers for Medicare & Medicaid Services (CMS) seeks feedback on how best to enhance Medicare Advantage (MA) data capabilities and increase public transparency.  With over half of Medicare beneficiaries, and 45 percent of rural beneficiaries, enrolled in MA, transparency about the program has become increasingly important.  In this request for information, CMS is seeking detailed information on common challenges and experiences in the MA program for which limited data are currently available.  Feedback may include data-related recommendations related to beneficiary access to care; prior authorization and utilization management strategies; cost and utilization of supplemental benefits; all aspects of MA marketing and consumer decision-making; care quality and outcomes; health equity; market competition; and special populations, such as individuals dually eligible for Medicare and Medicaid and other enrollees with complex conditions. They encourage input from beneficiaries and beneficiary advocates, plans, providers, community-based organizations, researchers, employers and unions, and the public at large.

Comment by May 29.

Read the full article here.

The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on the information collection requirements in two key areas for rural stakeholders:

1. CMS Plan Benefit Package and Formulary 2025: Medicare Advantage and Prescription Drug Plan organizations are required to submit plan benefit packages for all Medicare beneficiaries residing in their service area. These include information on premiums, formularies, cost sharing, prior authorizations, and supplemental benefits. This information is commonly reviewed by beneficiaries on Medicare Plan Finder, which allows beneficiaries to access and compare Medicare Advantage and Prescription Drug plans.
2. Satisfaction of Nursing Homes, Hospitals, and Outpatient Clinicians Working with the CMS Network of Quality Improvement and Innovation Contractors Program:  CMS is also seeking input on revisions to its data collection requirements for several health care provider-focused quality improvement surveys that are part of the Network of Quality Improvement and Innovation Contractors Program. CMS made these changes to inform its evaluation of technical assistance provided to nursing homes and outpatient clinicians in community settings, as well as to hospitals.

Comment by February 26.

Read the full article here.

According to the Centers for Medicare & Medicaid Services (CMS), a record number of people renewed their health coverage or became newly enrolled using either a federally facilitated marketplace or a state-based marketplace. Historically, about 18 percent of plan selections were from consumers living in rural areas.   While the annual Open Enrollment Period has ended, those no longer eligible for Medicaid or CHIP will have a special enrollment period to enroll in Marketplace coverage. Additionally, eligible individuals with household incomes less than 150% of the federal poverty level (approximately $22,000/year for an individual and $45,000/year for families of four) can enroll in Marketplace coverage anytime through a special enrollment period. Consumers who experience a change of life circumstance — such as marriage, birth, adoption, or loss of qualifying health coverage — may also be eligible for a special enrollment period. Consumers may go to Find Local Help on HealthCare.gov to find a Navigator, Certified Application Counselor, or agent or broker.

Read the full article here.

Last week, the U.S. Department of Health and Human Services (HHS), through the Administration for Strategic Preparedness and Response, announced new efforts in ongoing work to protect the healthcare sector from cyberattacks.  What’s new is a set of cybersecurity performance goals that are designed to improve the response to attacks and minimize residual risk. A recent analysis by HHS reports that federal law enforcement agencies are now treating cyberattacks on hospitals as “threat to life” crimes, and that rural hospitals face additional challenges, including antiquated hardware and software systems, rising cybersecurity insurance premiums, and securing talent with the right technical skills.

Read the full article here.