Senators push back on DEA proposed telehealth rules, say they'd affect patient care

In a letter to Anne Milgram, administrator of the Drug Enforcement Administration, they say Congress created a special registration under the SUPPORT Act "not as an option for DEA to utilize, but a requirement."
By Andrea Fox
11:17 AM

Photo: Samuel Corum/Stringer

This is a developing story with updates expected.

U.S. Senators Mark Warner (D-Va.), John Thune (R-S.D.) and four of their colleagues expressed support for the Drug Enforcement Administration's new engagement on a potential special registration for telehealth with this week's listening sessions hosted by the DEA's Drug Diversion Control Division, but said they had several concerns.

For starters, DEA’s proposed telehealth rules would drastically affect patient care, in that the rule would prevent doctors from prescribing controlled substances without an in-person visit going forward and place unnecessary requirements on care providers – despite efforts to ensure continued access to telehealth services following the end of the COVID-19 Public Health Emergency, according to an announcement from Warner's office.

The senators have reservations about patients getting appointments within 30 days, as well as the safety of providers who would have to provide their home address if they have a home office. There are also the difficulties of prescribing under a group National Provider Identifier number, and general record-keeping burdens the senators indicate may be unnecessary.

"A 30-day supply could result in patients going without their medication while they wait for an in-person appointment or will turn to higher-acuity and higher-cost settings of in-person care to meet this deadline, such as emergency departments," the senators said in Wednesday's letter.

"Despite the 180-day grace period after the end of the PHE, new and existing patients will be seeking in-person appointments simultaneously in a health care system that is already burdened by a shortage of health care providers. 

"According to the U.S. Department of Health and Human Services, 163 million Americans live in Mental Health Care Health Professional Shortage Areas. 

"Approximately 8,200 additional psychiatrists would be needed nationwide just to remove this shortage designation.

"Nationwide averages also obscure the variation among states and territories; for example, Arizona has only 8.5% of its psychiatric health care needs met and would need 227 psychiatrists to meet 100% of these needs.

"And beyond mental healthcare, 100 million Americans live in Primary Care Health Professional Shortage Areas, with more than 17,000 primary care providers needed at a minimum to remove the designation," they said in the letter. 

Creating a controlled substance registry for telehealth providers

The senators also noted in their letter to Milgram that Congress created a special registration under the SUPPORT Act "not as an option for DEA to utilize, but a requirement to do so." 

"We do not believe this [Notice of Proposed Rulemaking] fulfills DEA’s obligation to create a special registration," they said.

In May, the DEA extended telehealth prescribing flexibilities and said listening sessions September 12-13 were an opportunity to provide input on prescribing controlled substances via telemedicine platforms, on detecting diversion and about implementing safeguards that can prevent and detect drug diversion.

"The flexibilities that Administrator Milgram has afforded America for the last three years have fundamentally changed access for millions of Americans," Robert Krayn, CEO and cofounder of Talkiatry, told Healthcare IT News by email. 

"Make no doubt, we’re on the precipice of history. We have the opportunity to resolve a special registration process under this administration that’s been evading multiple administrations for decades," he said.

Andrea Fox is senior editor of Healthcare IT News.

Healthcare IT News is a HIMSS Media publication.

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