Lawmakers Put Public Pressure on Biden Administration to Make Audio-Only MAT Initiation Permanent

Members of Congress are pressuring two federal agencies to keep some pandemic-era telehealth flexibilities for medication-assisted treatment (MAT) in place.

Reps. Ann McLane Kuster (D-N.H.) and Lori Trahan (D-MA) wrote and released a letter sent to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) asking the agencies to allow practitioners to start buprenorphine treatment via audio-only telehealth visits.

In July, the Centers for Medicare & Medicaid Services included provisions allowing opioid treatment programs to start buprenorphine via audio-only telehealth in the proposed rule for the 2023 Medicare Physician Fee Schedule. The final rule will be released around the beginning of November.


“The Physician Fee Schedule proposed rule regarding coverage of audio-only telehealth for buprenorphine initiation depends on if ‘buprenorphine is authorized by the DEA and SAMHSA at the time the service is furnished,’” the letter states

Specifically, Trahan and Kuster call for a publicly detailed timeline for rulemaking around audio-only visits to start buprenorphine treatment. The representatives are also pushing for federal agencies to develop a long-term policy for the practice based on present utilization and effectiveness data, and consider them within the context of the Trump-era public health emergency declaration regarding opioid deaths; the declaration has been renewed by the Biden administration as well.

The lawmakers cite several studies that have found the COVID-era telehealth flexibilities have proved effective at increasing retention in MAT treatment and COVID magnified barriers to care established by “stringent regulations regarding medication-assisted treatment.”


“Harmonizing policy around the initiation of buprenorphine to treat OUD with the declaration of a public health emergency for the opioid crisis is a positive step to support providers who are on the front lines of the opioid crisis,” the letter states. “The current unpredictable future of coverage for audio-only telehealth for buprenorphine creates additional barriers for patients and uncertainty for health care professionals in an already underserved workforce as the need for addiction specialists with clinical knowledge of MAT continues to grow.”

Some stakeholders are pushing to deregulate MAT, especially for buprenorphine. The Association for Behavioral Health and Wellness, a payer advocacy group, supports eliminating the X waiver, a federal regulation that requires special registration and training for providers to treat people with buprenorphine. This measure is included in The Mental Health and Well-Being Act which was passed by the U.S. House of Representatives in June.

MAT and telehealth regulations are up in the air as Congress has yet to finalize its approach to a raft of proposed changes to federal behavioral health regulation. Some advocates in the space worry that telehealth will have limited utility going forward if pre-COVD era regulations kick back in without major federal reform.

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