Members of Congress are pressing federal agencies to maintain certain pandemic-era telehealth flexibilities that have significantly increased Telehealth MAT access for individuals with opioid use disorder (OUD). Representatives Ann McLane Kuster (D-N.H.) and Lori Trahan (D-Mass.) recently sent a letter to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA), calling for audio-only telehealth visits to remain an approved method for initiating buprenorphine treatment.
The COVID-19 pandemic prompted temporary changes to healthcare regulations to ensure patients could safely access care while minimizing in-person contact. For those struggling with OUD, these changes meant treatment programs could utilize telehealth—including audio-only visits—for starting buprenorphine, a critical medication in MAT. Preserving these flexibilities is seen as a vital step to sustain and expand Telehealth MAT access, especially for patients in rural or underserved areas.
CMS Provisions Highlight Need for Policy Clarity
In July, the Centers for Medicare & Medicaid Services (CMS) included provisions in the proposed 2023 Medicare Physician Fee Schedule that would allow opioid treatment programs to start buprenorphine via audio-only telehealth. The final rule is expected in early November. The CMS proposed rule notes that coverage depends on whether “buprenorphine is authorized by the DEA and SAMHSA at the time the service is furnished,” underscoring uncertainty for healthcare providers and patients if federal guidance is not standardized.
Kuster and Trahan’s letter specifically calls for a publicly detailed timeline for rulemaking around audio-only visits. They emphasize the importance of using current utilization and effectiveness data to guide policy, ensuring that Telehealth MAT access continues beyond temporary waivers and remains a safe, evidence-based option for patients.
Telehealth’s Role in Expanding Access to MAT
During the pandemic, telehealth became a lifeline for many patients who otherwise faced significant barriers to treatment. Research cited by Kuster and Trahan shows that COVID-era telehealth flexibilities improved patient retention in MAT programs. Audio-only telehealth visits, in particular, expanded Telehealth MAT access for patients without reliable internet connections or video-capable devices.
By maintaining these flexibilities, federal agencies can help sustain the progress made in reducing treatment gaps. Harmonizing MAT policy with the ongoing public health emergency declaration for the opioid crisis—originally enacted under the Trump administration and extended by the Biden administration—is crucial to protect Telehealth MAT access for both providers and patients.
The Need for Long-Term Policy
A major concern among advocates is the unpredictability of MAT regulations once pandemic-era waivers expire. Without clear, long-term policies, healthcare providers face uncertainty in how they can legally initiate buprenorphine treatment via telehealth. For patients, this uncertainty could disrupt care, particularly for those who rely on remote access due to transportation barriers, childcare responsibilities, or work obligations.
Kuster and Trahan’s call for long-term policy emphasizes the importance of data-driven decision-making. Aligning regulations with current usage and treatment outcomes can help ensure that Telehealth MAT access remains a permanent, reliable option for patients nationwide.
Deregulation Efforts and the X-Waiver
In parallel with maintaining telehealth flexibilities, some stakeholders are pushing for broader deregulation of MAT. The X-waiver, which requires special registration and training for providers to prescribe buprenorphine, has been criticized for limiting provider participation and restricting patient access.
The Association for Behavioral Health and Wellness supports eliminating the X-waiver, a change included in the Mental Health and Well-Being Act passed by the U.S. House in June. Advocates argue that removing this barrier, combined with sustained audio-only telehealth options, will dramatically expand Telehealth MAT access and ensure patients can more easily connect with qualified providers.
Supporting Providers and Patients
Healthcare providers who deliver MAT are already working in a high-demand, underserved environment. The uncertainty surrounding telehealth coverage adds stress and complicates care delivery. Maintaining audio-only telehealth and streamlining provider regulations supports clinicians and improves Telehealth MAT access for patients who need timely treatment.
The letter from Kuster and Trahan emphasizes that audio-only telehealth for buprenorphine is not merely convenient—it is essential for improving treatment retention, reducing overdose risk, and expanding recovery opportunities. Ensuring that patients can access treatment remotely strengthens the overall response to the opioid crisis.
Looking Ahead
As Congress and federal agencies weigh these issues, the future of MAT and telehealth remains uncertain. Advocates are urging decisive action to protect Telehealth MAT access, remove unnecessary regulatory barriers like the X-waiver, and align policy with the ongoing public health emergency. Preserving these flexibilities is a critical step in expanding care and supporting both providers and patients.
The opioid crisis continues to affect communities nationwide, and ensuring patients have reliable access to treatment is a key component of the response. Federal decisions in the coming months will determine whether the country sustains the progress made during the pandemic or reverts to restrictive pre-COVID regulations. Protecting Telehealth MAT access ensures that treatment remains available, equitable, and effective for all who need it.
