For veterans that have had an in-person visit with Veterans Affairs’ providers, the Drug Enforcement Administration is extending those provider-patient relationships to all VA practitioners engaging in telemedicine with the patient, DEA said in a statement Friday.
Jointly released with the Department of Justice, the Substance Abuse and Mental Health Services Administration and the Department of Health and Human Services, the new final rule says VA telehealth prescribers do not have to take part in a new Special Registration for controlled substances prescribed in virtual care.
WHY IT MATTERS
Because it is a nationally integrated, closed healthcare system, the VA has “rigorous internal policies and controls that ensure patient safety, continuity of care and thorough monitoring of prescriptions,” DEA said in its notice of proposed rulemaking.
The new rule, Continuity of Care via Telemedicine for Veterans Affairs Patients, requires VA telehealth prescribers to review and update the patient’s VA electronic health record and review the prescription drug-monitoring program data for the state in which the VA patient is located at the time of the telemedicine visit before prescribing a schedule II-V controlled substance.
If either the VA EHR or the state PDMP data is not available, the practitioner must limit the prescription to a seven-day supply until able to access both records, the agency said in its notice in the Federal Register.
The DEA explained in its notice that structuring the requirements differently for VA and non-VA practitioners enhances safety without imposing unnecessary restrictions on the veterans’ healthcare delivery model.
Because VA practitioners have access to shared information systems, including an internal prescription database, they can adequately “monitor and manage controlled substance prescriptions,” the agency said.
“This infrastructure ensures the safety of telemedicine prescribing without necessitating an additional registration layer, as VA practitioners operate within a highly regulated and cohesive system tailored specifically to veterans’ needs,” said DEA.
Effective Feb. 18, the VA exemption from the special registration for telehealth prescribers does not apply to community care network providers or others or conducting disability compensation evaluations, the agency said in the notice.
THE LARGER TREND
DEA said its intention with three new telehealth rules is to balance access to virtual care for the long term. Temporary exemptions to the Ryan Haight Act, issued and extended in response to the COVID-19 pandemic and recovery, end this year.
The general rule, which the agency is accepting public comments on, applies the “necessary safeguards against the diversion or misuse of controlled substances,” across the larger healthcare sector, DEA said.
One of the government’s concerns has been the practice of visiting multiple healthcare providers across non-integrated systems to obtain multiple prescriptions, known as “doctor shopping,” which the agency has said drives drug diversion.
However, according to an American Telemedicine Association reaction statement, DEA’s proposed framework for the new special telehealth registry holds significant implications for providers.
“Early indications suggest the proposed rule includes elements that represent significant operational challenges,” Kyle Zebley, senior vice president of public policy for the ATA and executive director of ATA Action.
Also on Friday, DEA published the Expansion of Buprenorphine Treatment via Telemedicine Encounter. This rule allows providers to prescribe a six-month initial supply to treat opioid use disorder via audio-only telemedicine interaction without a prior in-person evaluation.
“DEA and HHS believe that expanding access to buprenorphine through audio-only telemedicine outweighs the relatively lower risk of misuse and diversion of buprenorphine,” the agency said.
ON THE RECORD
“The proposed expansion of authorized internet prescribing for VA practitioners responds directly to the evolving landscape of the healthcare needs of VA patients, advancements in telemedicine and DEA’s capacity to implement safeguards that protect against potential misuse,” the agency said in the notice.
“VA now has improved tools and data systems, including enhanced monitoring of telemedicine practices and centralized systems like the VA’s internal prescription monitoring database, allowing for more effective oversight than what was available in the past.”
Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.
Source : Healthcare IT News