AHA Requests Information on Telehealth Prescriptions for Controlled Substances

December 05, 2022 - Representing nearly 5,000 member hospitals, health systems, and other healthcare organizations, a letter from the American Hospital Association (AHA) asked that the Drug Enforcement Administration (DEA) clarify future telehealth regulations for prescribing controlled substances and provide recommendations for an interim plan.

Before the COVID-19 pandemic, some policies prohibited the use of telehealth for certain medical activities. For example, the Ryan Haight Act of 2008 amended the Controlled Substance Act to eliminate providers' ability to prescribe controlled substances through telehealth with no in-person visit beforehand. The act detailed the need for initial in-person evaluations before virtual prescribing controlled substances.

However, exceptions to the in-person visit requirement can be enacted during public health emergencies (PHEs). This led the DEA to temporarily lift the in-person visit requirement during the COVID-19 pandemic, allowing patients to continue receiving controlled substance medications.

Through the pandemic, the flexibilities helped support patients in various ways, including enabling prescriptions of controlled substances to be delivered via telehealth and allowing providers to use telephone evaluations to initiate buprenorphine prescribing, the AHA noted.

The AHA sent the letter to the DEA to obtain further information regarding the future of these telehealth flexibilities. About 14 years ago, the Ryan Haight Act established the requirement that agencies issue a regulation that outlines the special registration process for telemedicine to waive the in-person requirement. Three years ago, the SUPPORT Act reinforced this policy.

However, providers are continuing to wait for guidance with the concern that the expiration of the COVID-19 PHE will put them in a position where they cannot provide treatment.

"With the expiration of the COVID-19 PHE currently scheduled for next year, this situation could come to pass as early as mid-January," the AHA wrote.

Thus, the AHA has asked the DEA to provide proposed rules for the special registration for telemedicine process, noting that issues such as staffing shortages, provider burnout, and financial constraints would benefit from more time to reallocate resources to operationalize new regulation requirements.

The letter also included a request for the DEA to provide an interim plan to support the continuity of care between the expiration of the COVID-19 PHE and the implementation of the special registration for telemedicine final rules.

According to the AHA, the interim plan should include waiving the in-person requirement for prescribing buprenorphine. Further, the waiver should be transitioned and incorporated under the Opioid Epidemic PHE, according to the association.

The letter also recommends that the DEA provide patients engaged in an episode of care that began virtually before the end of the COVID-19 PHE with a solution and support those who initiated an episode of care between the end of the COVID-19 PHE and the establishment of the final rules for special registration for telemedicine.

The AHA letter comes as healthcare stakeholders urge Congress to solidify various telehealth flexibilities enacted during the pandemic.

In December, a letter composed by the Connected Health Initiative (CHI) to the leaders of the US Senate and House Representatives asked that Congress continue the safe harbor for telehealth coverage by high-deductible health plans (HDHPs).

In this letter, CHI noted its support for removing restrictions to telehealth access facing Medicare beneficiaries; however, it also asked that Congress separately extend the safe harbor for HDHPs to cover telehealth with first-dollar coverage.