Wrapping it Up

January 15, 2021


HHS Expands Access to Treatment for Opioid Use Disorder

Eliminates X-Waiver Requirement for DEA-Registered Physicians
Today, the U.S. Department of Health and Human Services is announcing it will publish Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder*, to expand access to medication-assisted treatment (MAT) by exempting physicians from certain certification requirements needed to prescribe buprenorphine for opioid use disorder (OUD) treatment.

The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder issues an exemption from certain certification requirements under 21 U.S.C. § 823(g)(2) of the Controlled Substances Act (CSA) for physicians licensed under State law and who possess a DEA registration. Accordingly:

  • The exemption only applies to physicians who may only treat patients who are located in the states in which they are authorized to practice medicine.
  • Physicians utilizing this exemption will be limited to treating no more than 30 patients with buprenorphine for opioid use disorder at any one time (note: the 30 patient cap does not apply to hospital-based physicians, such as Emergency Department physicians).
  • The exemption applies only to the prescription of drugs or formulations covered under the X-waiver of the CSA, such as buprenorphine, and does not apply to the prescription, dispensation, or use of methadone for the treatment of OUD.

Here’s the press release from HHS:  https://www.hhs.gov/about/news/2021/01/14/hhs-expands-access-to-treatment-for-opioid-use-disorder.html

Last night, President-Elect Biden unveiled his proposal for the next round of COVID relief and stimulus, named the American Rescue Plan. The $1.9 trillion plan mirrors that of previous relief and stimulus packages, targeting health care and vaccine roll out, aid to schools, the economy and to families. Attached is a detailed summary of the proposed plan.

Of most importance to behavioral health care providers, the plan includes the follow provisions:

  • Expanding access to behavioral health services. The pandemic has made access to mental health and substance use disorder services more essential than ever. The president-elect is calling on Congress to appropriate $4 billion to enable the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration to expand access to these vital services.
  • Preserving and expanding health coverage. Roughly two to three million people lost employer sponsored health insurance between March and September, and even families who have maintained coverage may struggle to pay premiums and afford care. Further, going into this crisis, 30 million people were without coverage, limiting their access to the health care system in the middle of a pandemic. To ensure access to health coverage, President-elect Biden is calling on Congress to subsidize continuation health coverage (COBRA) through the end of September. He is also asking Congress to expand and increase the value of the Premium Tax Credit to lower or eliminate health insurance premiums and ensure enrollees – including those who never had coverage through their jobs – will not pay more than 8.5 percent of their income for coverage. Together, these policies would reduce premiums for more than ten million people and reduce the ranks of the uninsured by millions more.

Last night, Governor Cuomo publicly thanked Senator Chuck Schumer and President-elect Joe Biden for promising to release FEMA funds that will assist states to cover expenses associated with the COVID pandemic.  The commitment to NYS is to cover 100% of the state’s expenses, and is anticipated to deliver $2B to New York State.

Biden Appointee is well known, well regarded here in New York!
Dr. Patti Juliana, former Administrative Director of the Beth Israel Medical Center OTP, has been selected as the next Director for the CSAT Office of Pharmacologic Therapies. (OPT)

Throughout her career, Dr. Juliana has integrated and coordinated comprehensive treatment services to address a wide range of behavioral health needs and to reduce the barriers to service delivery that make it harder for people to access the care they need here in New York and across the country.  Dr. Juliana has conducted research studies at Albert Einstein College of Medicine and Mount Sinai Beth Israel Medical Center and has been published in a variety of journals and textbooks on issues related to families and substance abuse. She holds a Bachelor’s Degree from St. John’s University and both a Master’s and a Doctoral Degree in Social Work from Adelphi University. Click here for the SAMHSA CSAT DPT Director announcement

Update re: our OPRA discussions this week

This afternoon during the OMH & OASAS call intended for the 32 outpatient clinic providers already swept up in the OMIG OPRA audit, we did not hear anyone from either state agency say that it would be ‘illegal’ for providers to go back beyond the two year mark to add additional info to impacted claims.  Instead, Bob Hussar and I both heard them say that claims that are more than two years old are probably archived in the EMedNY system and so, DOH would likely need to grant access to these claims. OMH and OASAS will work with DoH on this  ‘ask’.

Second, while we do not believe it would be ‘illegal’ for OMIG to add Medicaid Managed Care claims to future OPRA audits, the fact is that as of today, the OMIG audit involves only outpatient clinics that bill using the same rate codes via APGs for FFS claims.  To this point, the breadth of the OMIG audit has been limited to a subset of providers that fit this criteria.  As we said yesterday, there is a larger OSC audit that (if implemented) could sweep up 382 outpatient clinics with the same criteria.  But as of today that larger audit has not been announced.  One of our objectives is to see to it that that larger audit does not move forward  But the suggestions Bob Hussar made to our members via the note I sent yesterday afternoon (after the morning call) stands.