AHA prods feds to allow addiction treatment prescriptions through telehealth
The AHA recommended that the DEA release proposed rules for telehealth special registration as soon as possible.
Photo: Geber86/Getty Images
The American Hospital Association has penned a letter to the Drug Enforcement Administration, asking the agency to extend and provide clarity to pandemic-era rules that allowed providers to prescribe addiction treatment drugs via telehealth.
Prior to the COVID-19 pandemic, the Ryan Haight Act of 2008 amended the Controlled Substances Act to prohibit prescribing of controlled substances via online forms, and outlined requirements for in-person evaluations prior to the prescribing of controlled substances. There are certain exceptions to the in-person visit requirement, including when there are public health emergencies.
During the COVID-19 PHE, the DEA enacted flexibilities to certain requirements to ensure patients could continue to receive medications virtually while minimizing exposure and preserving provider capacity. Flexibilities, including waiving the required initial in-person visit prior to prescribing controlled substances via telehealth, and allowing the use of telephone evaluations to initiate buprenorphine prescribing, have proved critical, according to the AHA.
These waivers have improved access to care for patients with substance-use disorder where there were already shortages in prescribers even prior to the pandemic, the group said.
"While waiving the in-person requirement has supported continuity of care in the interim, providers, hospitals and health systems need clarity on the permanent, post-pandemic process for virtual prescribing," the AHA wrote. "We envision that this will involve a special registration process for telemedicine to waive this in-person visit."
This registration process, according to the organization, was first established in the Ryan Haight Act and reinforced more than three years ago in the SUPPORT Act. The pending expiration of the COVID-19 PHE and its associated waivers, combined with the lack of a special registration regulation, will leave providers in a position where they'll need to cut services and leave patients without access to treatment, the AHA wrote.
The PHE is currently set to expire in mid-January, but the Department of Health and Human Services has yet to give providers 60-days notice before the end of the PHE.
WHAT'S THE IMPACT?
The AHA recommended that the DEA release proposed rules for telehealth special registration as soon as possible, and also urged the government to provide an interim plan to support care continuity between the PHE's expiration and implementation of the telehealth special registration, if indeed there's a gap period.
Among the AHA's suggestions for the interim plan are waiving the in-person requirement and continuing flexibilities for telephone evaluations to initiate buprenorphine prescribing. Given concerns regarding the expiration of the COVID-19 PHE, the AHA recommends transitioning this waiver for Substance Use Disorder under the Opioid Epidemic PHE, which does not have an anticipated end date.
The AHA also suggested providing a solution for patients engaged in an episode of care in which the episode was initiated via telehealth prior to the end of the COVID-19 PHE. Current waivers do not address how the in-person requirement will be addressed at the end of the COVID-19 PHE for open episodes, the group said; it recommends extending the waiver for an in-person exam for the duration of the episode.
Its final suggestion was providing a solution for patients who initiate an episode of care between the expiration of the COVID-19 PHE and publication of the final rule for special registration for telemedicine.
"Given the continued workforce challenges of today, we also urge the DEA to grant permanent exception for practitioners in states that have medical licensing reciprocity requirements to file separate DEA registration in any state a provider practices under the reciprocity arrangement to ensure appropriate prescribing for patients through telehealth services," the AHA wrote.
THE LARGER TREND
In October the Biden Administration extended the public health emergency for the 11th time since the declaration was first made in January 2020.
Health and Human Services Secretary Xavier Becerra issued another 90-day declaration on Thursday, October 13. The current extension ends January 11, 2023, Telehealth waivers granted under the public health emergency will expire 151 days after the end of PHE.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
