DEA Extends COVID-19 Teleprescribing Flexibilities through December 2024

NAHC

The Drug Enforcement Administration (DEA) on October 6, 2023 issued a temporary rule extending COVID-19 telemedicine flexibilities for prescribing of controlled medications through December 31, 2024, which is the current date for expiration of other telemedicine-related flexibilities. Prior to issuance of this temporary rule those flexibilities would have expired for new patients on November 11, 2023, and for existing patients on November 11, 2024.

The National Association for Home Care & Hospice (NAHC) submitted comments on the DEA’s proposed expiration of the flexibilities, urging the DEA to extend the COVID-19 prescribing flexibilities through the end of 2024, exempt hospice from any in-person requirements, and develop a registration process for practitioners who prescribe controlled substances via telemedicine encounters. In response to the dramatic outpouring of comments on its earlier notice regarding expiration of the flexibilities, DEA held listening sessions on September 12 and 13 to reopen the conversation and to gather input from various stakeholders. Partly in response to that input, DEA and the Department of Health and Human Services (HHS) made the decision to further extend the flexibilities.

As noted in the temporary rule, “In light of the need to further evaluate the best course of action given the comments received in response to the NPRMs and the presentations at the Telemedicine Listening Sessions, DEA, jointly with HHS, is issuing this second temporary rule…extending the full set of telemedicine flexibilities regarding prescription of controlled medications as were in place during the COVID-19 PHE, through December 31, 2024. This extension authorizes all DEA-registered practitioners to prescribe schedule II-V controlled medications via telemedicine through December 31, 2024, whether or not the patient and practitioner established a telemedicine relationship on or before November 11, 2023…The purpose of this Second Temporary Rule, like the one before it, is to ensure a smooth transition for patients and practitioners that have come to rely on the availability of telemedicine for controlled medication prescriptions, as well as allowing adequate time for providers to come into compliance with any new standards or safeguards.  DEA is working to promulgate new standards or safeguards by the fall of 2024.”

Senator Casey Unveils Legislation to Increase Medicaid Home Care Funding

NAHC

Senator Robert Casey (D-PA), a staunch friend of the elderly and disabled, has unveiled legislation that would provide a 10 percent increase to the federal share (FMAP) of home and community-based services (HCBS) for two years. The legislation would essentially extend the HCBS funding from the American Rescue Plan Act (ARPA) and provide states with an additional two years of funding. The draft legislation provides a list of allowable uses for the funding, including:

Increasing payments to HCBS and home health providers;

• Providing sick leave and benefits to workers;
• Reducing waiting lists for HCBS waivers;
• Worker recruitment activities; and
• Other activities approved by CMS.

According to the Pennsylvania Rehabilitation & Community Providers Association, Senator Casey intends to formally introduce the bill later in October.

NAHC has contacted the Senator’s office to request that the legislation specifically include Private Duty Nursing as a service included in the 10 percent increase.

Senate Special Committee on Aging Seeks Answers on Oversight of Medicaid Managed Care Organizations

Home Care Association of America

Senate Special Committee on Aging Chairman Bob Casey (D-PA) sent a letter to CMS seeking information and raising concerns about the oversight of Medicaid managed care organizations (MCOs). Citing a recent report from the Office of Inspector General, Sen. Casey expressed concern over health insurance companies denying medically necessary care for individuals enrolled in Medicaid MCOs.

​These MCOs receive fixed annual fees, known as capitated payments, from state Medicaid programs to provide health insurance to Medicaid enrollees. However, the letter highlighted the OIG's warning that such payment models can create incentives for insurance companies to deny services to increase profits. Sen. Casey's letter requests information on the steps being taken by CMS and states to protect Medicaid enrollees and ensure that MCOs prioritize patient care over profit margins.

CMS Proposes Changes to the HCBS 1915(c) Waiver Application

NAHC

In September 2023, the Centers for Medicare & Medicaid Services (CMS) posted proposed updates to the 1915(c) Home and Community Based Services (HCBS) Waiver Application and Technical Guide in the Federal Register for public comment. According to CMS, the changes include technical edits and updates throughout both documents, such as adding an option for states to indicate whether HCBS can be delivered via telehealth and integrating settings criteria with person centered service planning requirements.

Crosswalks of the major changes, as well as redlined and final versions of both documents are available here: 2023 1915(c) Waiver Application PRA Renewal Materials.

1915(c) waivers are flexible and extensive service packages and are the most predominant way that state Medicaid agencies provide HCBS across the country. Changes to the HCBS Waiver Application and Technical Guide can have significant impact on the way that states administer their benefits. The public comment period closes on November 13, 2023. The Federal Register posting, including instructions for providing public comment, is available here: Federal Register Notice for 1915(c) Waiver Application PRA Renewal.