C-TAC just submitted comments on a proposed DEA telehealth rule that, if finalized as proposed, would be expensive, difficult for hospice and palliative care providers, and ultimately reduce access to care.
During the COVID-19 public health emergency, providers were allowed to prescribe opioids and other controlled substances via telehealth under temporary flexibilities granted by the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS).
This proposed rule now seeks to make such telehealth more permanent but with the following problematic key changes:
- Special registration– Physicians and some non-physician practitioners (NPPs) will need to show legitimate need to get a $888 special registration and update it every 3 years to prescribe controlled substances via telehealth. This will be expensive for either the prescribers themselves or their organizations. The NPPs will have to be board certified in specific specialties, which will further limit how many could apply for such special registrations.
- Hospice and palliative care prescribers– They are among the few specialties who will qualify for this special registration but must have a telehealth interaction with the patient in order to prescribe controlled substances. While this makes sense for non-emergent situations, home-based palliative care or hospice prescribers are sometimes asked to order these medications for a patient they have not seen before. Having to schedule a telehealth visit in such a situation would be impractical or, in the case of an actively dying patient, impossible. Therefore, we recommended that hospice and palliative care prescribers be unfortunately exempted from this proposed rule.
- Audio-Video Telecommunication Systems– Prescribers must use audio-video telecommunication for any telehealth interaction unless the patient declines. This is problematic for those who lack access to smart phones, tablets, laptops, broadband, or cell phone service. Allowing audio-only telehealth was appropriate for patients during the COVID-19 public health emergency and we recommended that be the case here as well.
Read C-TAC’s full letter with additional areas of concern.
Finally, this rule was issued at the end of the Biden Administration and so it is also unclear whether the Trump Administration will implement it as proposed or make their own revisions. We will update C-TAC members on this in future newsletters.
