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Information for Addiction Treatment Providers During (And Beyond) COVID-19

By
Shatterproof's ATLAS Team

Shatterproof has compiled and is updating this list of resources to support addiction treatment providers in response to COVID-19.

Addiction treatment providers have always had to work hard for their patients, ensuring access to medications, counseling, and social supports. This work is often filled with obstacles, which providers are used to overcoming. So it’s not surprising that when faced with a new crisis in the form of COVID-19, providers have been quick to act, supporting their patients during these unprecedented times.

But challenges remain. And Shatterproof is here to support. Click here to access our complete list of resources for treatment providers, which is continuously being updated.

Read on to understand some of the changes and challenges that COVID-19 is bringing to the addiction treatment space.

Telehealth

To decrease in-person health visits during the current crisis, addiction treatment providers across the nation have switched their services to telehealth. This allows assessments, prescribing, counseling, group meetings, and more to happen by phone or webcam, which enables patients and prescribers to safely practice physical distancing, a COVID-19 precaution, while still providing or accessing necessary services. However, the switch to telehealth in addiction has required not only a technology change, but also a policy one.

To ensure addiction treatment providers can be reimbursed for telehealth services, states, such as Louisiana, have had to release guidance on how the services should be coded. In some states, additional clarity has been provided on acceptable mechanisms for delivering telehealth. For example, in Maryland, a memorandum has been released to clarify that audio-only services are reimbursable within Medicaid, though less preferable to telehealth technology or video services. Similar clarification has been provided in other states, like Indiana.

Although telehealth has previously been shown to increase access to addiction treatment, particularly in areas with capacity gaps, reimbursement for telehealth services of this nature has been nonexistent in many regions, due to legislative barriers. While telehealth may not be the right solution for all individuals in need of addiction treatment, particularly given that many in this population may lack phone or data capabilities, this change is an important step to expand access to critical services, during this pandemic and beyond.

Take-Home Meds

Medications for addiction treatment have long been subject to unique and stringent regulations. For example, historically, patients receiving methadone for the treatment of opioid use disorder were required to visit an Opioid Treatment Program (OTP) every day to access their medication. However, on March 16th, SAMHSA provided guidance for OTPs regarding take-home doses. Under this guidance, patients in OTPs who are deemed stable by providers may receive up to 28 days of take-home doses of methadone, and less stable patients can receive 14 days’ worth. This is a substantial and welcome change to the previously draconian daily attendance requirements.

While this is a temporary change to protect patients and the workforce in the wake of COVID-19, and must be enacted by each state, the guidance reveals fundamental issues with the addiction treatment delivery system. Returning to a system that requires daily visits for access to a highly effective treatment for a chronic illness would be a mistake in a post-COVID-19 world.

Personal Protective Equipment (PPE)

Despite efforts to expand services remotely and limit the need for in-person visits, not all elements of addiction treatment can be delivered virtually, or from six feet apart. That means providers and patients alike are at risk. The national shortage of personal protective equipment (PPE) endangers addiction treatment providers delivering critical services. This continues to be an issue in many states, and may be compounded by state guidance that prioritizes PPE for certain facilities, such as residential treatment, but not others, such as outpatient.

Privacy Laws and Funding

Addiction treatment has previously been handled differently from physical health, in particular in regards to privacy. A key example is 42 CFR Part 2, a privacy restriction that made it exceedingly difficult, if not impossible, for providers to coordinate care for those with addiction. The regulation prevented providers from sharing information about addiction treatment with a patient’s other non-behavioral health providers. However, the Coronavirus Aid, Relief, and Economic Security (CARES) Act recently eliminated this barrier by substantially changing 42 CFR Part 2, thus allowing for the sharing vital patient medical information among healthcare providers, while keeping critical privacy and discrimination protections in place.

The CARES Act also included $425 million in funding for The Substance Abuse and Mental Health Services Administration (SAMHSA), as well as funding for services that help support people’s recovery, such as housing. Additional funding is available for addiction treatment programs through the US Small Business Association and programs in select states, such as Delaware.

But despite bailout funding efforts, addiction treatment facilities, like most organizations across America, are concerned about keeping their doors open during these challenging times. For addiction treatment facilities, this is often due specifically to decreased revenue from changes in the services they can provide and the patient load they treat, as well as limitations with their own capacity as staff face health, housing, and childcare challenges. Ensuring the addiction treatment system receives adequate funding to support current populations with addiction and a flood of new need post-COVID-19 will be critical, and will require key resources, including new legislation.

 

Ultimately, much of the guidance released to ensure safe provision of addiction treatment during COVID-19 fundamentally changes the way these services are delivered. It’s noteworthy that some of these access-expanding changes are long overdue, and are a win to ensure patients can stay connected with treatment.

However, their fast passage at this time requires providers to adapt extremely quickly, often without financial or technological support. It will be crucial for addiction treatment providers to continue to be supported during this crisis—by states, payers, and communities alike—and for these regulation changes, which undo many ineffective, outdated policies, to stay, even after the pandemic is gone.

The addiction treatment system is rapidly adapting to a changing world and Shatterproof is here to help. Don’t hesitate to reach out if there are any unmet needs you’re facing, or if you have resources that are not currently included in the resource page.

Thank you, providers, for all you do.