Summary of Expansion of Induction of Buprenorphine via Telemedicine Encounter
The Drug Enforcement Administration (DEA) released its Notice of Proposed Rulemaking (NPRM) on buprenorphine via telemedicine encounter, a summary, and highlights for medical practitioners.
The proposed rule amends the DEA’s regulations, in concert with the Department of Health and Human Services (HHS), on the circumstances under which individual practitioners are authorized to prescribe schedule III-V controlled substances which are approved for treating opioid use disorder, either as medication maintenance or treatment for withdrawal management, referred to as maintenance or detoxification treatment via a telemedicine encounter, including an audio-only telemedicine encounter.
Specifically, the proposed rule provides requirements to check the Prescription Drug Monitoring Program (PDMP) prior to issuance of a prescription, 30-day limitations, in-person requirements for follow-up appointments, and more detailed requirements for record-keeping are expected to minimize the diversion of buprenorphine via telemedicine, including audio-only telemedicine.
For a full summary, click here or see below:
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Open in new tab Alliance for Connected Care and the American Telemedicine Association Disappointed in the Process for the Multi-Jurisdictional Contractor Advisory Committee on RPMs
The Alliance for Connected Care and the American Telemedicine Association sent a letter expressing disappointment in the process for evaluating Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM). The letter states that the time allotted to subject matter experts is not adequate and expresses concern about the bibliography provided to meeting participants last week, which is missing at least 45 studies by known clinical experts.
“We are concerned that advice rendered by the CAC in this instance will not be the result of a full scientific inquiry, nor will it help ensure unbiased or contemporary consideration of state of the art technology and science”
Watch the MAC meeting here.
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Alliance Statement on Cross-State Licensure in SOTU
We are grateful to President Biden for highlighting the pressing issue of cross-state licensure in advance of the State of the Union. The pandemic taught us that it is possible, and safe, to allow providers to treat patients anywhere. State borders should cease to be an artificial barrier to health care. It’s time to change the cumbersome, time-consuming, expensive, and duplicative licensing rules that prevent patients from receiving care from qualified, licensed providers in other states.
We would miss an opportunity if we approach this issue incrementally. Allowing cross-state treatment for one patient population or disease-type may have made sense as a first step before the pandemic, but we have had more than two years of access for patients in need of all types of services. We should change the status quo for all patients, regardless of diagnosis.
A Nationwide Telehealth Heart Failure Program: Can Remote Patient Monitoring and Guideline Directed Treatment Protocols Help Bridge the Gaps in Heart Failure Management?
A Nationwide Telehealth Heart Failure Program: Can Remote Patient Monitoring and Guideline Directed Treatment Protocols Help Bridge the Gaps in Heart Failure Management?
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Alliance Support Letter for Washington SB 5481 – Concerning the Uniform Telehealth Act
The Alliance submitted a letter of support to Annette Cleveland, Chair of the Senate Health & Long Term Care Committee within the Washington State Legislature, for Senate Bill 5481 – Concerning the Uniform Telemedicine Act.
The bill would adopt the Uniform Telemedicine Act in the State of Washington. The Uniform Telemedicine Act would provide the state with the clear guidance and framework needed to facilitate the delivery of services via telehealth consistent with the standard of care of the state in which the patient is located. It would also establish a registration system for out-of-state practitioners to provide telehealth services to patients located in the state adopting this Act, therefore enabling practitioners to provide widespread assistance to patients in a more convenient and cost-effective manner.
This bill would be a foundational first step to better facilitate the delivery of telehealth services and address the patchwork of licensure laws that exist from state to state to ensure patients can continue to be at the center of their care.
Read the full letter here and below:
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Alliance Submits Comments in Response to White House OSTP on Clinical Research Infrastructure and Emergency Clinical Trials
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The Alliance for Connected Care submitted comments in response to the request for information from the White House Office of Science and Technology Policy (OSTP) on clinical research infrastructure and emergency clinical trials .
The Alliance specifically outlined licensure restrictions that present a barrier to clinical trial recruitment and diversity and
present a recommendation for OSTP’s consideration.
As one goal of this emergency clinical trials initiative is to support the expansion of clinical research into underserved communities, and increase diversity among both trial participants and clinical trial investigators, the Alliance believes that continuing to modernize and decentralize clinical trials is critical for creating opportunities for more diversity and patient engagement.
To read the full letter, click here or see below:
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Letter to MACs About RPM Meeting
The Alliance for Connected Care joined a letter, led by the Connected Health Initiative (CHI).
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Alliance Urges CMS to Preserve Beneficiary Access to Telehealth Services
Action Needed to Align Payment with Congressional Authority
On January 13, 2023, the Alliance for Connected Care sent a letter to the Centers for Medicare & Medicaid Services (CMS) regarding the implementation of the telehealth provisions in the Consolidated Appropriations Act, 2023.
Some Medicare telehealth codes are currently scheduled to expire 151 days after the expiration of the COVID-19 public health emergency (PHE). While most telehealth codes can simply be extended in the annual calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS) rulemaking, the timeline is too rapid to address the issue.
The Alliance requests that CMS issue an interim final rule to implement the date changes as per the Consolidated Appropriations Act, 2023.
To read the letter, see below or click here.
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The Alliance for Connected Care also joined a larger stakeholder letter to CMS to extend the availability of the codes that are temporarily on the Medicare Telehealth Services List to align with the Consolidated Appropriations Act of 2023.
Longer-Term Effects of Remote Patient Management Following Hospital Discharge After Acute Systolic Heart Failure: The Randomized E-INH Trial
Longer-Term Effects of Remote Patient Management Following Hospital Discharge After Acute Systolic Heart Failure: The Randomized E-INH Trial
Background: The randomized INH (Interdisciplinary Network Heart Failure) trial (N = 715) reported that 6 months’ remote patient management (RPM) (HeartNetCare-HF) did not reduce the primary outcome (time to all-cause death/rehospitalization) vs usual care (UC) in patients discharged after admission for acute heart failure, but suggested lower mortality and better quality of life in the RPM group.
Objectives: The Extended (E)-INH trial investigated the effects of 18 months’ HeartNetCare-HF on the same primary outcome in an expanded population (N = 1,022) and followed survivors up to 60 months (primary outcome events) or up to 120 months (mortality) after RPM termination.
Methods: Eligible patients aged ≥18 years, hospitalized for acute heart failure, and with predischarge ejection fraction ≤40% were randomized to RPM (RPM+UC; n = 509) or control (UC; n = 513). Follow-up visits were every 6 months during RPM, and then at 36, 60, and 120 months.
Results: The primary outcome did not differ between groups at 18 months (60.7% [95% CI: 56.5%-65.0%] vs 61.2% [95% CI: 57.0%-65.4%]) or 60 months (78.1% [95% CI: 74.4%-81.6%] vs 82.8% [95% CI: 79.5%-86.0%]). At 60 and 120 months, all-cause mortality was lower in patients previously undergoing RPM (41.1% [95% CI: 37.0%-45.5%] vs 47.4% [95% CI: 43.2%-51.8%]; P = 0.040 and 64.0% [95% CI: 59.8%-68.2%] vs 69.6% [95% CI: 65.6%-73.5%]; P = 0.019). At all visits, health-related quality of life was better in patients exposed to HeartNetCare-HF vs UC.
Conclusions: Although 18 months’ HeartNetCare-HF did not significantly reduce the primary outcome of death or rehospitalization at 60 months, lower 120-month mortality in patients previously undergoing HeartNetCare-HF suggested beneficial longer-term effects, although the possibility of a chance finding remains.
Alliance for Connected Care Executive Director Featured in The Hill
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Krista Drobac, executive director of the Alliance for Connected Care, was featured in The Hill.
See below for an excerpt:
Clock is still ticking on virtual mental health prescribing
Congress acted last month to extend important telehealth flexibilities that will ensure millions of Americans and their providers will continue to have access to telehealth when the COVID-19 public health emergency is officially over. The importance of these policy extensions can’t be overstated. However, there is one remaining critical action item: prescribing for mental health and substance abuse treatment.
Read the full article here.
For more information about the Alliance’s advocacy in this area, see here.