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Public Health Emergency to End May 11

The federal Public Health Emergency (PHE) is scheduled to end of May 11, 2023, which will create changes to how healthcare has been delivered these past three years. Under the PHE, a number of restrictions were lifted to help patients receive services; many of the pre-pandemic rules will go back into place when the PHE ends. For example, health care professionals will be required to use a HIPAA-complaint software for telehealth, and DEA requirements will revert back to seeing a patient in person (at least once) if being prescribed controlled substances and procuring DEA registration in any state where they are prescribing controlled substances.

The DEA's proposed rule for prescriptions of telemedicine include controlled substances and medication for opioid use disorder. The following is a summary of the proposed rules:

Relationship between prescribing medical practitioner and patient


 Prescribing a non-controlled medication Prescribing Schedule III, IV, or V non-narcotic
controlled medications		 Prescribing buprenorphine as medication for opioid use disorder Prescribing Schedule II and/or narcotic controlled medications
Prior in-person medical evaluation by prescribing medical practitioner Permitted Permitted Permitted Permitted
Referral under the proposed rules from medical practitioner who conducted prior in-person medical evaluation Permitted Permitted Permitted Permitted

Telehealth visit without:

  • Prior in-person medical evaluation by prescribing medical practitioner; or
  • Referral from a medical practitioner who conducted prior in-person medical evaluation
 Permitted
  • Up to 30-day initial prescription
  • In-person visit required for additional prescription
  • Up to 30-day initial prescription
  • In-person visit required for additional prescription
 Not permitted

 

Other changes when the PHE ends will include:

  • Those with private insurance will no longer receive eight free at-home COVID tests each month, but those on Medicaid will be able to access COVID tests until 2024 under the American Rescue Plan.
  • In NC, an estimated 300,000 people will lose eligibility for health care coverage under Medicaid.
  • Those with private insurance will now pay a co-pay for treatments like Paxlovid as well as PCR tests.

Many states and insurers have made permanent changes to telehealth, which are no longer linked to the PHE. The Consolidated Appropriations Act of 2023 extended telehealth flexibilities for Medicare patients, including postponing in-person requirements until at least the end of 2024.

For psychiatrists who transitioned from an office-based to a hybrid or fully virtual role, the APA has created several resources to help make sense of the expected changes to come:

  • “Best Practices in Synchronous Videoconferencing-Based Telemental Health”: This document provides guidance on addressing the key administrative, technical, and clinical considerations when using a telehealth platform. The document—which covers such topics as legal and regulatory issues as well as telehealth platforms—was created by a joint writing committee drawn from the APA Committee on Telepsychiatry and the American Telemedicine Association Telemental Health Special Interest Group.

  • “What Happens When the Public Health Emergency Ends? Telepsychiatry and Hybrid Practice Post-PHE”: This webinar—featuring a 60-minute presentation exploring some of the regulations to change when the PHE lifts followed by a Q&A—was recorded on January 11. It was hosted by Shabana Khan, M.D., the director of the child and adolescent telepsychiatry program at NYU Langone Health, and John Torous, M.D., director of digital psychiatry at Beth Israel Deaconess Medical Center. Khan is the chair of APA’s Committee on Telepsychiatry, and Torous is the chair of APA’s Committee on Mental Health Information Technology.

  • “Comparison of Telehealth Provisions During & After the Public Health Emergency”: This table summarizes the topics discussed in the webinar mentioned above and provides a quick reference on the telehealth provisions enacted during the PHE, their likely status post-emergency, and anticipated kick-in date.

APA is now working to update and create additional materials about some of the changes to expect in May when the PHE lifts. APA members can also expect additional webinars, podcasts, blog posts, FAQ documents, and more on a range of technology topics in the months ahead.

 Resources

  1. DEA Proposed Rules for Permanent Telemedicine Flexibilities (Feb. 24, 2023)
  2. DEA's Proposed Telemedicine Regulations, Highlights for Medical Practitioners