Telehealth Intake at an OTP: Audio-Video, Audio-Only and When Each Applies

Before 2024, starting treatment at an opioid treatment program (OTP) meant an in-person examination at the program. The 2024 rule made telehealth part of intake for the first time in Part 8, as SAMHSA's table of changes explains: it "allows screening patients for initiation of buprenorphine via audio-only or audio-visual telehealth technology if certain providers determine that an adequate evaluation of the patient can, or has been, completed via telehealth," and "allows for screening patients for the initiation of methadone via audio-visual telehealth under certain conditions."

What counts as telehealth under Part 8?

Part 8 defines telehealth broadly as "the delivery and facilitation of health and health-related services including medical care, counseling, practitioner, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies," including "Health Insurance Portability and Accountability Act (HIPAA)-compliant video and audio-only communication platforms" (42 CFR 8.2). The intake rule then sets which form may be used for which medication.

Which examinations can be done remotely?

An OTP's initial medical examination has two parts: a screening examination to confirm the patient meets admission criteria and has no contraindications, and a full history and examination of broader health status (42 CFR 8.12(f)(2)(i)). Treatment may begin once the screening examination is complete, assuming no contraindications (8.12(f)(2)(ii)).

Both may be completed by telehealth "for those patients being admitted for treatment at the OTP with either buprenorphine or methadone, if a practitioner or primary care provider, determines that an adequate evaluation of the patient can be accomplished via telehealth" (8.12(f)(2)(v)).

When is audio-only allowed?

It depends on the medication's schedule (8.12(f)(2)(v)(A)-(B)):

• Methadone (Schedule II). "Audio-visual telehealth platforms must be used, except when not available to the patient." When not available, audio-only is acceptable "but only when the patient is in the presence of a licensed practitioner who is registered to prescribe (including dispense) controlled medications."
• Buprenorphine (Schedule III) and naltrexone (not controlled). "Audio-visual or audio only platforms may be used."

In every case, "the OTP practitioner shall review the examination results and order treatment medications as indicated."

Does anything still have to happen in person?

Yes. "A full in-person physical examination, including the results of serology and other tests that are considered to be clinically appropriate, must be completed within 14 calendar days following a patient's admission to the OTP." A non-OTP practitioner may complete it if an OTP practitioner verifies it as true and accurate and it is transmitted under applicable privacy laws (8.12(f)(2)(iii)). The physical and behavioral health assessment and the initial psychosocial assessment with a care plan are also due within 14 calendar days of admission (8.12(f)(4)(i)).

A related flexibility: if the screening examination is done by a licensed practitioner who is not an OTP practitioner, it must be completed no more than seven days before admission, and the results must be sent to the OTP and verified by an OTP practitioner (8.12(f)(2)(ii)).

What about counseling by telehealth?

Part 8 lists counseling among the services telehealth covers, and Medicare's OTP benefit pays for counseling and therapy that "can be conducted via two-way audio-video communication," according to CMS's OTP page. Payer rules on audio-only differ, so check each payer before scheduling it. Our sister site covers audio-only telehealth rules across programs.

Which other rules still apply?

• DEA rules for prescribing. Part 8's intake rule governs examinations for medication dispensed by the OTP. Prescribing controlled medications by telemedicine outside the OTP falls under DEA's own rules; see our sister site's post on the buprenorphine telemedicine rule.
• State law. Licensing, telehealth and OTP rules may add conditions. Part 8 does not limit the state's authority over MOUD (8.11(e)(1)).
• Confidentiality. OTP records are governed by 42 CFR Part 2 and HIPAA (8.11(e)(3)), and the telehealth platform must fit both. See Part 2 consent and the Patient Notice.

What should the intake policy say?

1. Who determines whether an adequate evaluation can be done by telehealth, and how that determination is documented.
2. The modality rules by medication, including the presence requirement for audio-only methadone screening.
3. How outside screening results are received, verified and dated against the seven-day window.
4. How the 14-day in-person physical examination and assessments are scheduled and tracked.
5. Platform, privacy and consent requirements under Part 2 and HIPAA.
6. State-specific limits.

How do we help?

Our Policy and Procedure Manual add-on ($1,495) writes the intake, telehealth and examination policies to 42 CFR 8.12, your accrediting body's elements and your state rule, and our Part 2 Policy Alignment ($395) updates consent and notice templates. These are policy templates and readiness work, not legal advice, and clinical decisions remain with your practitioners. See the 2024 rule and pricing.