On May 10, 2023, the Department of Justice, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services published a “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” (the “Temporary Rule”). This FAQ is intended to provide guidance to providers on the Done platform and Done employees regarding the impact of the extension and the impacts on Done’s operation.
1. What exactly was extended and for how long?
The Temporary Rule is clear about its primary purpose: “The full set of telemedicine flexibilities regarding prescription of controlled medications as were in place during the COVID–19 PHE will remain in place through November 11, 2023.” This means that the status quo as it relates to telemedicine flexibility for the prescribing controlled substances will remain in place until November 11, 2023.
2. Why does the Temporary Rule reference a “grace period” until November 11, 2024?
The Temporary Rule provides a “grace period” until November 11, 2024 for patient provider relationships “established” on or before November 11, 2023. This means, according to the Temporary Rule, that “the full set of telemedicine flexibilities regarding prescription of controlled medications as were in place during the COVID–19 PHE will continue to be permitted via a one-year grace period through November 11, 2024. In other words, if a patient and a practitioner have established a telemedicine relationship on or before November 11, 2023, the same telemedicine flexibilities that have governed the relationship to that point are permitted until November 11, 2024.”
3. How does the “grace period” impact the necessity of in-person visits?
Based on the language of the Temporary Rule, provided a patient-provider relationship is established by November 11, 2023 (this includes existing patients and any patients that sign up before that date), no in-person visit will be required until November 11, 2024.
4. Does the Temporary Rule impact the ability to prescribe in states where a provider doesn’t have a DEA license?
At least until November 11, 2023, subject to state law, the PHE exception allowing providers to write prescriptions for patients in other states via telemedicine remains in place. As a reminder, here is the guidance issued on March 25, 2020 (which, to be clear, remains in place until November 11, 2023):
[T]o allow practitioners to prescribe controlled substances in states in which they are not registered if the practitioner is registered with DEA in at least one state and has permission under state law to practice using controlled substances in the state where the dispensing occurs. In other words, under this exception, a DEA-registered practitioner is not required to obtain additional registration(s) with DEA in the additional state(s) where the practitioner's dispensing (including prescribing and administering) occurs if the practitioner is authorized to dispense controlled substances by both the state in which the practitioner is registered with DEA and the state in which the dispensing occurs. Practitioners may utilize this temporary exception via in-person prescribing or prescribing via telemedicine. Id. 802(54)(D). A practitioner using this exception must continue to comply with the laws and regulations of the state in which they are DEA-registered, and the laws and regulations of the state in which they are practicing, if different.
In short, on a Federal level, the Temporary Rule maintains the PHE status quo. In states that do not have conflicting regulations, providers with DEA licenses may prescribe in other states where doing so is permissible under state law.
However, in the interest of ensuring best-in-class compliance and patient service, and because the Temporary Rule has no impact on state rules, Done will begin transitioning patients to providers who hold licenses in the states of the patients’ residency.
Until further notice, providers should continue to serve their out-of-state patients. Clinical leaders will provide period updates about these transitions.
5. What does this mean for Done’s long term plans?
Although there is a possibility that these changes will eventually become permanent, Done plans to operate as if the Temporary Rule will expire on November 11, 2023 and providers nationwide will be required to comply with pre-PHE requirements. As a result, Done intends to continue scaling in-person and collaborative care capabilities.
6. Who should I reach out to with questions about the Temporary Rule and Done’s operations?
Clinical providers should continue to reach out to their Clinical Lead. Done Global employees should reach out to firstname.lastname@example.org.
7. Should I continue asking patients for the QTR forms or requiring an in-person evaluation?
We are proud that we can offer patients a number of different options that provide options to fit their lifestyles. In preparation for the end of the Temporary Rule, we intend to continue to provide QTR and in-person evaluation options for future Done users.
We are dedicated to providing all of our patients with the necessary care they need and with the Public Health Emergency coming to an end on May 11, 2023. We have enacted measures to guarantee continued care for our patients; this includes adapting to In-person and Hybrid setups in various states in accordance with all state laws and regulations.
Done. implements a hybrid model that can incorporate both the requisite regulations in the industry but also the greatest malleability to meet patient needs. Hybrid care is defined as a blend of in-person with virtual coverage to provide a holistic option for the patient and provider to achieve the greatest clinical outcomes possible. We achieve this through a "direct" and collaborative care model. We combine Done’s ongoing virtual care offering with high-touch in-person care through Done.’s independent partner psychiatric expert clinicians consultations at Done. offices, partner clinician in-person consultations, and trusted provider referrals maximize access to the best psychiatric care available.
How does it work?
Existing patients who are prescribed a controlled substance before May 10, 2023: The DEA will require a qualified referral on file before November 7, 2023 to continue treatment with controlled medications via telehealth. Patients can also choose to meet one of our providers in-person at one of our multiple locations.
New patients who need controlled substance prescriptions after May 10, 2023: The DEA will require patients who plan to use telemedicine services to manage their prescription to have a qualified referral on file before starting treatment. Patients can also choose to meet one of our providers for an in-person appointment.
A qualified referral is a referral that comes from a provider that sees you, it can be your primary care physician or your local provider. By submitting this form, they can request that you can manage your controlled substance prescriptions via telehealth with Done. Depending on the state, this form should be submitted every few months, and will require an in-person physical examination as well.
How to get a qualified referral before Nov 7, 2023
Provide this referral form to your local practitioner or primary care doctor. You can send the link, download and email the pdf, or print it out and bring it to your next appointment.
Ask your practitioner to complete the referral form: your practitioner will request that Done. continues your care and prescription management virtually.
Upload this form in your patient portal or email it to our care team at email@example.com
If your doctor has questions, you can direct them to our post-pandemic telehealth care page for providers.
Done will be sure to update all stakeholders should there be any changes in the future pertaining to healthcare requirements in their respective states.
We would like to reassure all patients that they will be able to receive continued care if they fulfill the previously established care requirements implemented by their providers on Done platform or their referrer providers.
As of March 27, 2023, Done has accommodated patients for in-person appointments in the states of Georgia, Louisiana, Mississippi, New Jersey, South Carolina, Texas, and Utah, and Done plans to implement the hybrid care model for all of our supported states.
We understand some concerns regarding the continuation of care under digital health platforms such as Done., but we can guarantee that we are constantly updating our practices to ensure that we remain compliant with the ever-changing healthcare landscape. Done. will continue to adhere to all by-laws set by governing bodies, and any resulting changes will have no impact on the care patients are receiving.
Please feel free to contact us at firstname.lastname@example.org for further clarification or any other concerns.