NEWSLETTER 
Volume 3, Issue 9 - March 3, 2023

The DEA has announced proposed permanent rules for the prescribing of controlled medications via telemedicine. The press release is below along with a pretty useful info-graphic. CSAP is working hand in hand with the APA on how to provide feedback to these proposed rules.

WASHINGTON - Today, the Drug Enforcement Administration announced proposed permanent rules for the prescribing of controlled medications via telemedicine, expanding patient access to critical therapies beyond the scheduled end of the COVID-19 public health emergency. The public will be able to comment for 30 days on the proposed rules.

The proposed rules – developed with the U.S. Department of Health and Human Services and in close coordination with the U.S. Department of Veterans Affairs – propose to extend many of the flexibilities adopted during the public health emergency with appropriate safeguards.

• Telemedicine consultations that do not involve the prescribing of controlled medications.

• Telemedicine consultations by a medical practitioner that has previously conducted an in-person medical examination of a patient.

The proposed rules also would not affect:

• Telemedicine consultations and prescriptions by a medical practitioner to whom a patient has been referred, as long as the referring medical practitioner has previously conducted an in-person medical examination of the patient.

The proposed rules would provide safeguards for a narrow subset of telemedicine consultations—those telemedicine consultations by a medical practitioner that has: never conducted an in-person evaluation of a patient; AND that result in the prescribing of a controlled medication. For these types of consultations, the proposed telemedicine rules would allow medical practitioners to prescribe:

• a 30-day supply of Schedule III-V non-narcotic controlled medications; 

• a 30-day supply of buprenorphine for the treatment of opioid use disorder

without an in-person evaluation or referral from a medical practitioner that has conducted an in-person evaluation, as long as the prescription is otherwise consistent with any applicable Federal and State laws. The proposed rules are explained in further detail for patients and medical practitioners on DEA.gov.

“DEA is committed to ensuring that all Americans can access needed medications,” said DEA Administrator Anne Milgram.  “The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” said HHS Secretary Xavier Becerra. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in-person. At HHS, we are committed to working with our federal partners and stakeholders to advance proven technologies and lifesaving care for the benefit of all Americans.”

The proposed telemedicine rules also further DEA’s goal of expanding access to medication for opioid use disorder to anyone in the country who needs it. “Medication for opioid use disorder helps those who are fighting to overcome substance use disorder by helping people achieve and sustain recovery, and also prevent drug poisonings,” said DEA Administrator Milgram. “The telemedicine regulations would continue to expand access to buprenorphine for patients with opioid use disorder.”

The full text of the proposals may be found here and here. The public has 30 days to review and comment on the proposals, which DEA will then consider before drafting final regulations. DEA is appreciative of the public’s feedback.

For more information on DEA’s continued efforts to expand access to medications used in treatment for those suffering from opioid use disorder, visit: DEA’s Commitment to Expanding Access to Medication-Assisted Treatment.

Additional resources for patients can be found here: 

• Is My Prescription a Controlled Medication? Controlled-Non Controlled List (dea.gov)

• Can My Medication be Prescribed through Telemedicine?  Controlled Substance Guidance (dea.gov)

Additional resources for practitioners can be found here:

• Proposed Rules Summary Telemedicine Rules Summary.pdf (dea.gov)

• Proposed Rules Highlights for Medical Practitioners Telehealth Practitioner Narrative.pdf (dea.gov)

You may also view an article from the National Law Review: DEA’s Proposed Rules on Telemedicine Controlled Substances Prescribing after the PHE Ends. 

Prescribing Issues

CSAP and SYASL will meet next week with staff for Attorney General Rob Bonta as well as staff at the Board of Pharmacy. We will raise every issue that any of you have brought to our attention. Stay tuned... 
 

Mental Health Initiatives 

The Assembly Health Committee and the Assembly Budget Subcommittee on Health and Human Services held a status hearing on the numerous California mental health initiatives authorized over the last several years. You may view hearing materials and SYASL staff notes below. This is a great way to get caught up or refresh your awareness of myriad processes currently in process.

• Agenda for February 28th Hearing
• SYASL Staff Notes
• CPEHN_Building-Culture-and-Gender-Responsive-Emergency-Services February 28th
• CPEHN Asm Budget Sub 1 Presentation February 28th
• LAO_Overview of Major Recent Behavioral Health Initiatives February 28th
• CYBHI Workstreams February 28th
• CYBHI Milestones and Spending Plan February 28th
• CPEHN_Medi-Cal-Managed-Care-Plan-Mental-Health-Services February 28th
• CPEHN_CDEPs One-Pager February 28th
• CHCF Testimony Katie Heidorn
• CDPH Behavioral Health Fact Sheet February 28th
• Background for February 28th Hearing
   

San Francisco's Drug Overdose Prevention Sites

The San Francisco Board of Supervisors have approved legislation introduced by Mayor London Breed and Supervisor Hillary Ronen that opens the door for non-profits to operate drug overdose prevention sites in San Francisco with private funding. Today’s vote removes a recently identified permitting barrier to moving forward with a non-city funded overdose prevention program while the City waits for federal guidance on whether it can fund such programs with public dollars. Read more. 
 

Incompetent to Stand Trial

The Department of State Hospitals has released a progress report of unreconciled data for the second quarter (October 1, 2022, through December 31, 2022) of FY 2022-23 provided in reference to the FY 2021-22 baseline numbers. Please see the links below for more information. 

Quarter 2 Progress Memo
IST Referrals for Growth Cap - FY 2022-23
IST Penalty Calculation Sheet
Felony IST Growth Cap DL 22-003
Felony IST Growth CAP FAQs
 

Behavioral Health Rights Act

The Steinberg Institute has shared with CSAP and SYASL the language that  they intend to amend into AB 459 (Haney). We have discussed this in previous newsletters: it is an effort to put into state law rights similar conceptually to what is in statute with respect to developmental services. 
 
The Steinberg Institute has branded this proposal the "Behavioral Health Rights Act". This branding is meant to reinforce that access to quality care is a human right, yet people living with mental health and substance use disorders continue to face discrimination in receiving the care they need to live full lives. The bill is focused on both the public and private systems of care and includes 4 key components: 

• Bill of Rights
• Mandatory Minimum Set of Services
• Outcomes and Accountability Framework
• Risk Corridor Funding Stratification 

You may view the language here and a fact sheet here. Feedback on this? Please email Paul Yoder.
 

CMA

CMA Seeks Your Input 

CMA is seeking patient and health care provider stories about the prior authorization process AND access issues in the Medi-Cal system and would love your help!  At either of the links below, physicians can choose to record a short video or share their written experiences. Either way, CMA will use the stories in its collective efforts to change and improve the systems. 

Prior Authorization: If you have waited days or months for an insurance company to approve a treatment prescribed by your doctor, CMA wants to hear from you. If you are a physician frustrated with the administrative headaches and their impact on your patients, CMA wants to know your story. https://www.cmadocs.org/priorauth
 
Medi-Cal: Share your unique experience as a Medi-Cal patient, physician or health care professional. Whether your experience has been good or bad, your story will help shed light on why the Medi-Cal system is vitally important to every Californian and why access must be must improved.  https://www.cmadocs.org/your-story
 

Fed / APA Update 

President-Elect 

Ramaswamy Viswanathan, M.D., DrMedSc, DLFAPA was chosen by APA members to be the next President-Elect of the association.  Dr. Viswanathan’s term as President-Elect will begin at the conclusion of the Annual Meeting this May, and he will assume the Presidency the following year in May 2024. You can read about Dr. Viswanathan’s priorities for his presidential year and see the full APA election results here.

Collaborative Care Model Residency Education Conference 

APA is looking to train future psychiatrists and primary care physicians in the Collaborative Care Model (CoCM) and will be hosting a conference in Washington, DC from April 24-25, 2023 for psychiatry and primary care residency programs on how to teach the Collaborative Care Model training programs.

APA will cover the travel / housing / per diem expenses for one training director or faculty and one resident from each program to attend this conference. In return, asking residency program to incorporate CoCM into your curriculum. 

APA is encouraging psychiatry and primary care residency programs to attend together.  Applications from both a psychiatry residency program and primary care residency program will receive priority.

To apply for this opportunity, please fill out the form here by Friday, March 17.  Each application will require a letter of support from the Chair of your Department, which will include the people attending and highlight your program’s commitment.  Please contact Agathe Farrage at afarrage@psych.org with any questions. 

State Updates

DHCS CYBHI EBP/CDEP Round 2: Trauma Informed Programs and Practices RFA Webinar

You may view the slide presentation from the DHCS CYBHI Round 2: Trauma Informed Programs and Practices RFA Webinar here. 

Grant Opportunities and Opportunities for Public Comment 

For SYASL's latest compilation of draft behavioral health regulations and grant opportunities, see here. 
 

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