Opioid Training Now Required for All DEA-Registered Providers

The US Drug Enforcement Administration (DEA) issued a letter outlining the training that will meet the requirements of the Medication Access and Training Expansion (MATE) Act that was passed as part of the Consolidated Appropriations Act of 2023.

The letter also states that, effective June 27, 2023, physicians will be able to simply check a box on their DEA registration application or renewal form indicating that they have satisfied this training requirement.

The new DEA letter appears to be largely consistent with the recommendations that the American Medical Association (AMA) made to the DEA in a letter earlier this month. The AMA letter notes, the AMA Ed Hub has multiple offerings “on the treatment and management of patients with opioid or other substance use disorders,” which are included in the AMA's Opioid Therapy and Pain Management CME course. Using the new DEA guidance, the AMA is thoroughly reviewing these materials to determine which ones to include in a dedicated web page that will soon be created to help physicians and other practitioners satisfy the one-time, eight-hour training requirement.

To view the DEA letter, click the button below.

Political Dynamics Hinder Progress on Women’s Health

As reported in the March 31 edition of the IMA Weekly Legislative Update, HB 374 to update Idaho’s Total Abortion Ban statute passed the House & Senate and now heads to the Governor for his signature. 

Based on guidance from the House of Delegates, IMA went into the 2023 Legislature with a goal to fix Idaho’s abortion laws to ensure that physicians can provide evidence-based care for pregnancy complications. IMA sought legislation to do the following:

• Replace the affirmative defense standard (guilty until proven innocent) with true exceptions
• Preserve the life and health of the mother, including her ability to have children in the future
• Allow exceptions for severe mental illness in which the life of the mother is at risk
• Allow exceptions for lethal fetal anomalies inconsistent with life outside the womb
• Allow exceptions for pregnancy caused by rape or incest without a police report

IMA drafted and shared legislation with all of the provisions listed above. Based on strong pushback from legislators, it quickly became apparent that exceptions for mental health and lethal fetal anomalies were off the table. The IMA lobby team, per guidance from House and Senate leadership, engaged in a negotiation process with Idaho Chooses Life.

Those negotiations resulted in HB 342, which removed the affirmative defense and had an expanded exception for the life of the mother that included treatment for conditions that would become life-threatening if left untreated – seen by many as a partial health exception. However, the night before the hearing on the bill, the Idaho Republican Party issued a statewide release (see excerpt below.) 

In the end, the “life-threatening” language became problematic because some legislators viewed it as too broad and could allow abortion on demand. On the other hand, Democrats were not convinced the bill went far enough and could not muster support. In addition to concerns from legislators, there were also disputes among other pro-life organizations about the bill language and disagreement on how to fix it. Due to this lack of support, HB 342 was held in committee without a hearing.

That is how we ended up with HB 374, which removes the affirmative defense but does not address the health of the mother, only her life. The bill provides exceptions for ectopic or molar pregnancy, removal of a dead unborn child, and treatment of a woman who is no longer pregnant. HB 374 still contains an exception for rape and incest with a copy of a police report, which the victim is entitled to within 72 hours. Even though it isn’t the full array of fixes we sought, HB 374 is progress from current law and is supported by the IMA.

Most importantly, our work isn’t done. We have commitments from legislators to keep working on this issue. Throughout the process on HB 342 and 374, IMA heard consistently from legislators their strong recognition and desire to do more to address the health impacts of pregnancy complications. Because IMA stayed engaged in negotiations and supported even small steps forward, our team will have an opportunity to be at the table for discussion of future fixes.

IMA is in active conversation at this very moment about next steps. We want physicians to know those discussions appear fruitful and could lead to breakthrough legislation – while not everything we are looking for, there is potential for meaningful improvements.  

U.S. Health Law’s Preventative Care is in Jeopardy

Requirements for preventative coverage are driven by recommendations by the U.S. Preventive Services Task Force, comprised of volunteers. However, a Texas federal judge struck down a narrow but critical part of the nation’s health law that requires most insurers to cover preventive services that include screenings for cancer, diabetes, and mental health. The same judge tried to dismantle the Affordable Care Act in the past.

Previously, the Supreme Court overturned the judge’s ruling that the entire health care law, also known as “Obamacare,” was unconstitutional. The judge ruled that enforcing the recommendations was “unlawful” and a violation of the Constitution’s Appointment Clause, which lays out how government officials can be appointed.

Opposition to this ruling has stated that this will jeopardize preventive care for millions of Americans. Chairman of the federal task force, Dr. Michael Barry, made a statement following the ruling that people with low incomes have been able to get services they need as care has expanded over the past decade because of the law.

The ruling applies to recommendations made by the task force after March 2010, when the Affordable Care Act was enacted. Some of the nation’s largest medical groups also came out against the lawsuit, warning that insurers in the future could impose cost-sharing on patients for screenings that are now fully covered.

CMS Changes for Advanced Care Planning

By Jana Weis, Gill Compliance Solutions

Advance care planning (ACP) is a CPT service that can occur face-to-face and via telehealth, per Medicare guidelines. Patients have several options to make their wishes known if they cannot make their own medical decisions. Often this information is expressed through a living will, healthcare proxy, durable POA, or psychiatric advance directive. CMS has recently added medical orders for life-sustaining treatment to serve as an advance directive. Documentation and coding rules can be tricky with this series of codes. Below are several changes to documentation requirements effective as of February 2023.

CMS requires a provider/QHP to document the ACP discussion with a patient, family member, caregiver, or surrogate. Documentation should include:

• The voluntary nature of the visit
• The explanation of advance directives
• Who was present
• The time spent discussing ACP during the face-to-face encounter
• Any change in health status or health care wishes if the patient becomes unable to make their own decisions
• Report the ICD-10 as the condition you discuss with the patient (or an administrative exam if part of an AWV or IPPE)
• Only include time for this service, especially if performing as part of another problem-oriented E/M service 

Claims processing notes:

• If billed with an AWV or IPPE (same date) or with modifier -33, patient coinsurance will be waived by CMS. This code is allowed 1x per year as part of a preventative benefit.
• If billed on a different date (as CMS does not cap the use of this code), and the preventative has been used, the patient will be subject to deductibles and coinsurance as part of their Medicare plan.

More information can be found here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AdvanceCarePlanning.pdf