The Drug Enforcement Administration (DEA) has proposed rules that if finalized would allow limited flexibilities for prescribing controlled substances without an in-person visit after the public health emergency (PHE) ends on May 11. The public may submit comments on the proposed rules until March 31 at the Federal Register’s website here and here.
During the PHE, a number of restrictions on the use of telehealth were waived so that patients could receive services, including mental health services, without leaving their homes. One of the major flexibilities allows psychiatrists to prescribe controlled substances to patients without an in-person visit. With the end of the PHE, some of those waivers are scheduled to be lifted.
However, on February 24, the DEA released a statement announcing proposed rules that would allow medical practitioners to continue to prescribe via telemedicine in limited circumstances. These include allowing physicians to prescribe a short-term supply (30 days) of Schedule III-V non-narcotic controlled medications and/or buprenorphine for the treatment of opioid use disorder before an in-person exam is required and allowing a referring practitioner to conduct the required in-person exam.
Among the pre-pandemic regulations that will return is a requirement that health care professionals use HIPAA-compliant messaging software for telehealth; under the PHE, physicians and other health care professionals can use popular technology, such as Skype and FaceTime, to conduct telehealth sessions.
The future of telehealth regulations after the end of the PHE is highly variable. For instance, some states and health care plans—recognizing that telehealth has now become a permanent feature of health care—may continue certain flexibilities and coverage; commercial and Medicaid payers may vary widely in their telehealth policies. APA members are urged to follow the APA telepsychiatry blog for up-to-date information about rules; they should also contact the APA Practice Management Helpline, their APA district branch, state medical board, liability insurance carrier, or other trusted resource for information about the status of telehealth coverage for their patients.
In the meantime, telehealth experts advise psychiatrists to work with their patients to begin planning now for how the end of the PHE may affect their care. “As a first step, clinicians should explain to patients that due to new changes in the law, there may be some changes in how [telehealth] versus in-person visits are offered,” John Torous, M.D., chair of APA’s Committee on Mental Health IT, told Psychiatric News. “For practices, now is a good time to make sure you understand new requirements around HIPAA-secure telehealth systems, changes in billing codes, and changes in state licensure issues that could impact which patients you can legally see via telehealth.”
For more information, see the Psychiatric News article “If You Are Treating Patients Virtually, Begin Planning Now for End of COVID-19 PHE.”
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