April 21, 2023
The DEA proposed new rules in February 2023 in an attempt to balance safe prescription practices with the increasing dependence on remote healthcare providers- and the new guidelines seem to be a mix of pre-COVID and pandemic rules.
To be clear, these new rules apply only when:
The new rules make prescribing controlled substances through virtual care more difficult and may increase financial and administrative burdens for behavioral health organizations.
The DEA’s proposed guidelines fall into two categories: in-person visit requirements, and record-keeping requirements. Since these regulations aren’t funded, they represent an additional burden on providers and their organizations, who risk fines or losing their license if they don’t comply.
If a patient has been referred to a virtual care prescriber by a clinician who has seen them in person, the prescribing practitioner may issue a prescription based on a “qualifying telemedicine referral.”
If no in-person evaluation has occurred, the provider must comply with the Prescription Drug Monitoring Program, limit prescriptions to a single 30-day supply of certain medications for addiction treatment, conduct a medical evaluation meeting specified criterion, and comply with all record-keeping requirements.
The proposed rules would require some in-person visits and additional record-keeping, adding complexity to the work of behavioral health organizations.
While some organizations already incorporate in-person visits or referrals in their business models, for others, the proposed rules could disrupt operations and patient care. Companies whose care models rely on remote prescribing could lose patients.
As patients rush to identify an in-person prescriber who can provide continuity of care under the proposed changes, in-person behavioral health organizations and other providers may experience a backlog of referral requests. Alternatively, patients may seek emergency room care to receive the required in-person evaluation, which may lead to overcrowding and longer wait times.
The most immediate impact will be felt by patients who are currently receiving prescriptions from a provider they have never met in person. These individuals may no longer be able to receive their prescriptions through remote consultations alone and will need to find a prescriber who can examine them in person. People living in rural areas or with transportation or disability limitations may find these challenges especially difficult.
After behavioral health organizations and their patients navigate the short-term logistics of complying with the new regulations, the industry will have to brace for possible long-term implications.
The new regulations could lead to a worst-case scenario of reduced use of outpatient services and programs. In-person visits are time-consuming and expensive. As a result, patients may disengage from their care, resulting in increased hospitalizations or emergency room visits, which are more costly and less effective. In addition, the complexity of the new requirements may limit innovation and growth in the field.
The proposed changes may, however, lead to improved quality of care for behavioral health organizations. By evaluating patients face-to-face and tailoring treatment plans to individual needs, providers could improve outcomes and improve satisfaction. In addition, this could promote an integrated approach to mental health care, where mental health symptoms are treated as well as the whole person.
Either way, the DEA’s proposed rules are a significant development for behavioral health organizations and prescribing providers. While the changes have the potential to disrupt operations and negatively impact patients, they may also address some of the lax prescribing policies that have come under fire during the Covid era. Overall, these changes underscore the importance of finding a balance between safe prescribing practices and remote healthcare access, a tension that will continue to shape behavioral healthcare.