So, Ryan Haight waiver likely coming to an end soon?

Started by Dopamemes
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Dopamemes

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We're less than 4 weeks away from expiration of the waiver. What do you guys think the odds are that it's not renewed this time? My job already requires us to see everyone in-person once a year anyway but I imagine this is going to hit the telemedicine folks pretty hard.
 
Curious for updates on this as well as I’m 100% telehealth for the outpatient part of my job. From what I’ve seen/read highly likely it’s just going to get extended again. Honestly would be a relief for me if it wasn’t, but as long as they’re open I’m guessing they’ll just do what they’ve done the last few years.
 
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Dopamemes said:
How does that follow? Agree that the government is disorganized, but that makes it more likely that they’ll let it lapse.
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Sure, but they also generally like to maintain status quo and not make major waves in healthcare unless they can somehow take credit for it. It would be very easy for them to just vote to extend the deadline for what’s already in place. That’s what they’ve done yearly since 2022 when they declared the COVID emergency over. There’s no reason to believe they won’t just do the same again now that the previous shut down has ended.
 
Stagg737 said:
Sure, but they also generally like to maintain status quo and not make major waves in healthcare unless they can somehow take credit for it. It would be very easy for them to just vote to extend the deadline for what’s already in place. That’s what they’ve done yearly since 2022 when they declared the COVID emergency over. There’s no reason to believe they won’t just do the same again now that the previous shut down has ended.
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You mean, other than the fact that they let the Medicare telemedicine waiver expire despite renewing it yearly since 2022? This almost exclusively affects psychiatric medications (few people are rx'ing opioids via telemedicine). This administration has made their views on psychiatric medications pretty clear. We've got 18 working days until the DEA waiver expires. It's never gotten this close before.
 
Dopamemes said:
How does that follow? Agree that the government is disorganized, but that makes it more likely that they’ll let it lapse.
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Over a year ago, the DEA asked for public comments regarding some changes. The public comments didn’t go as well as hoped. To get to that point, thousands of hours were spent at a cost of millions of tax payer dollars.

Currently, the government is pushing a reduction in workforce. The DEA has provided 0 new amendments for comment.

If my job were at risk, I’m claiming more time and expertise is needed to figure out the best way forward and sign the extension.

Not signing the extension appears like an admission that there is no better path forward and the money/time was poorly spent. Bad optics.

This is all my speculation, but if it were me at this point, I’m kicking the can down the road.
 
Dopamemes said:
You mean, other than the fact that they let the Medicare telemedicine waiver expire despite renewing it yearly since 2022? This almost exclusively affects psychiatric medications (few people are rx'ing opioids via telemedicine). This administration has made their views on psychiatric medications pretty clear. We've got 18 working days until the DEA waiver expires. It's never gotten this close before.
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That occurred because of the shutdown, it was reinstated and is effective again until the end of January. They did the same for behavioral health visits. Telehealth policy updates

As much as I dislike the current administration (and the last several for that matter) this isn't particularly unique or new. Congress under Biden waited until last minute, current congress has done the same. It probably feels more last minute (and somewhat is) because we just got out of the longest fed shutdown in history. The headless chickens are still scrambling and have other fires to put out.

As I said above, I frankly would not mind at all if the telehealth exceptions for stimulants weren't continued. This won't affect 90%+ of the meds we prescribe and as Atreides mentioned the proliferation of online pill mills giving out stimulants like candy is a major problem both in terms of safety of our patients and reputation of our field. As much as I can't stand MAHA, online prescribing of controlled substances is one point (maybe the only one) that I think they're probably more right than wrong about.

TexasPhysician said:
This is all my speculation, but if it were me at this point, I’m kicking the can down the road.
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Congratulations, you've already met 80% of the criteria for a role of influence in our federal government!
 
Idk, we've got 6 Federal working days left till it expires. Last minute extension seems increasingly unlikely.
 
MrFlyGuy said:
So did they extend it?

If not, that means we have to see patients on controlled substances in person before prescribing a stimulant even if they are a long term telepatient?
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www.chesshealthsolutions.com

DEA Extends Telemedicine Flexibilities for Controlled Substance Prescribing Into 2026 - CHESS Health Solutions

The DEA plans to extend telemedicine flexibilities for controlled substance prescribing into 2026, allowing clinicians to continue remote prescribing while agencies finalize long-term rules. Learn what this means for providers and health systems.
www.chesshealthsolutions.com www.chesshealthsolutions.com

The DEA passed an extension, the details of which have not been published.
 
PsyDr said:
www.chesshealthsolutions.com

DEA Extends Telemedicine Flexibilities for Controlled Substance Prescribing Into 2026 - CHESS Health Solutions

The DEA plans to extend telemedicine flexibilities for controlled substance prescribing into 2026, allowing clinicians to continue remote prescribing while agencies finalize long-term rules. Learn what this means for providers and health systems.
www.chesshealthsolutions.com www.chesshealthsolutions.com

The DEA passed an extension, the details of which have not been published.
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No, it’s still pending review by OMB. Review is taking inexplicably long. As it stands now, the extension is still expiring at the end of the month.
 
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Atreides said:
I mean, we have two days left at this point.
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You're right. Something is wrong, but this is strange. It gets posted. It gets through review. What's going on? Did it get pulled last minute? Why? It seems really irresponsible to end what has been a policy for almost six years without any guidance. Even if you're ending it, post something saying so with some runway to help patients transition. The last official statement from the DEA about this was months ago stating that telehealth prescribing was being made permanent with some caveats, and all recent indications from inside sources was that it was getting extended and they were working on some kind of permanent solution. I mean, they literally posted a "fourth extension" to the OMB.
 
Well if it doesn't go through, I have a road trip to look forward to (I found a new psychiatrist before moving to CA, and in moving I didn't know where in CA I'd be living, so I found one in a somewhat arbitrary location).

I wonder if a lot of people would end up in ERs if it doesn't go through? I have no idea, but I kind of think practical concerns like that are why they'll maintain the status quo.
 
SoulinNeed said:
Here it is. It's scheduled to be published tomorrow in the Federal Register. It's another year extension.

Federal Register :: Request Access

www.federalregister.gov www.federalregister.gov
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The feds waiting until the last minute to pass a policy?!? Gasp!!!

Seriously though, neither side of the aisle would be helped by not passing this and neither side wants changes to healthcare unless they can either take credit for something or blame the other side. Bipartisan stuff like this almost always goes though. Once again much ado about nothing.
 
Stagg737 said:
The feds waiting until the last minute to pass a policy?!? Gasp!!!

Seriously though, neither side of the aisle would be helped by not passing this and neither side wants changes to healthcare unless they can either take credit for something or blame the other side. Bipartisan stuff like this almost always goes though. Once again much ado about nothing.
Click to expand...

So we will probably get to look forward to these extensions being passed for the next decade every year at the last minute, just like the famous "Doc Fix" Congress ritualistically voted for every year to keep Medicare payments from being slashed by . . . legistlation Congress had passed.
 
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