Telehealth Providers: Begin Planning Now for End of COVID-19 PHE
Abstract
Many telehealth flexibilities will end on May 11. However, last month the DEA proposed two rules to allow limited flexibility around the prescribing of controlled substances, including buprenorphine, without an in-person visit after the public health emergency (PHE) ends.
Psychiatrists who have been treating patients virtually under relaxed regulations governing telehealth as part of the COVID-19 Public Health Emergency (PHE)—especially those prescribing controlled substances and/or seeing patients across state lines—should begin planning with patients now for the end of the PHE when some of those flexibilities will phase out.
The Biden administration announced on January 30 that the PHE, which started in 2020, will end on May 11. During the emergency, 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. With the end of the emergency, some of those waivers will be lifted, and several pre-pandemic regulations will be back in effect.
For example, health care professionals will be required to use HIPAA-compliant messaging software for telehealth; under the PHE, physicians and other health care professionals will no longer be able to use popular technology, such as Skype and FaceTime, to conduct telehealth sessions.
Additionally, with limited exceptions, health care professionals registered with the Drug Enforcement Administration (DEA) will be required to have an in-person visit with patients to prescribe controlled substances.
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.
The proposals appear as two separate rules in the Federal Register (Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have not Had a Prior In-Person Medical Evaluation, and Expansion of Induction of Buprenorphine Via Telemedicine Encounter). Look to Psychiatric News and the Psychiatric News Alert for updates about the proposed rule.
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.
Because of the shifting nature of regulations around telehealth after the end of the PHE, APA members are urged to 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 say that psychiatrists who provide telehealth services should pay special attention to requirements regarding in-person exams and DEA registration requirements to prescribe controlled substances across state lines.
“When the flexibilities expire in May, there is a risk that many of these patients may be left abruptly without care,” says Shabana Khan, M.D., chair of the APA Committee on Telepsychiatry.
“There are a lot of patients who have been receiving care through telemedicine the past three years and were being prescribed a controlled substance for their condition,” said Shabana Khan, M.D., chair of APA’s Telepsychiatry Committee. Pending approval of the proposed DEA rules, Khan said some of those patients may be left without care if alternate arrangements are not made.
Many individual states had already terminated PHE flexibilities involving cross-state licensure, but Khan offered the example of a young person relocating to an out-of-state college as one in which the end of cross-state telehealth may complicate care.
“If you have been treating a patient for years in your home state and now that patient is going away to college, your ability to continue to provide care through telehealth will depend on whether you are licensed in that state.”
John Torous, M.D., chair of APA’s Committee on Mental Health IT, noted that the benefits of being able to treat patients across state lines has created new interest among advocacy groups, including APA, in advocating for new rules to allow this flexibility to continue. “Clinicians should keep checking the APA telepsychiatry blog as rules may continue to change, and it is possible extensions could come,” he told Psychiatric News.
Khan and Torous urge psychiatrists to begin talking with their telehealth patients now and planning for how the end of the PHE may affect their care.
(The AMA’s Principles of Medical Ethics notes that when physicians are withdrawing from a case, they should notify the patient or authorized decision maker long enough in advance to permit the patient to find another physician and to facilitate transfer of care when appropriate.)
“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,” Torous said. “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.” ■
