DEA Extends Telehealth Flexibilities for Six Months

NHPCO

The Drug Enforcement Agency (DEA) has extended “the COVID-19 telemedicine prescribing flexibilities for six months, from May 12, 2023 through November 11, 2023.” The following requirements must be met for the flexibilities to continue:

1. The prescription must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.
2. The prescription must be issued pursuant to a communication between a practitioner and a patient using an interactive telecommunications system…[e.g.,] audio and video equipment permitting two-way, real-time, interactive communication.
3. The practitioner must be authorized under their registration…to prescribe the basic class of controlled medications specified on the prescription or exempt from obtaining a registration to dispense controlled medications.
4. The prescription must be consistent with all other [prescribing] requirements.

On March 1, 2023, a proposed rule was published in the Federal Register focused on telemedicine prescribing of controlled substances when the practitioner and the patient have not had a prior in-person medical evaluation. This proposed rule applies only in limited circumstances when the prescribing practitioner wishes to prescribe controlled medications via the practice of telemedicine and has not otherwise conducted an in-person medical evaluation prior to the issuance of the prescription. NHPCO submitted comments and will provide additional updates as they are finalized.

CDC Issues Guidance for Masking in Health Care Settings

NAHC

The Centers for Disease Prevention and Control (CDC) has issued revised guidance for Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic .

The guidance applies to all health care settings and provides a framework to implement select infection prevention and control practices based on their individual circumstances. Specifically, CDC added an appendix to assist facilities with how and when to implement broader use of  source control (masking).  CDC also announced that it will no longer be collecting information needed to track the community transmission rates of COVID-19.

There are several considerations that CDC addresses that will help guide when a broad use of masking in the healthcare settings should be implemented.

• The types of patients cared for in their facility.
• Input from stakeholders.
  • Reviewing plans with stakeholders including patient and family groups and healthcare personnel can help determine the most appropriate infection control practices for staff and patients.

• Facilities might tier their interventions based on the population they serve. For example, facilities might consider a lower threshold for action in areas of the facility primarily caring for patients at highest risk for severe outcomes (e.g., cancer clinics, transplant units). Home health and hospice agencies might consider establishing  policies for masking when caring for patients with a  high risk for contracting infectious diseases.

• Plans from other facilities in the jurisdiction with whom the facility shares patients.
  • Some jurisdictions might consider a coordinated approach for all facilities in the jurisdiction. Input from local hospitals and other healthcare providers can help inform the agency’s policy for masking.

• What data are available to make decisions.
  • Facilities and jurisdictions might have access to more granular data for their jurisdiction to help guide efforts locally. Agencies should work with their local  public health departments for community transmission data.

Unfortunately, with the end of the public health emergency, CDC will no longer receive data needed to publish Community Transmission levels for SARS-CoV-2. CDC will continue to collect and report SARS-CoV-2 hospital admissions data on the CDC COVID Data Tracker, although not as accurate as community transmission levels for COVID-19 surveillance.  These data continue to be available at the county level and are used by CDC to help the public decide when masking in the community should be considered.

CDC is in the early stages of developing metrics that could be used to guide when to implement select infection prevention and control practices for multiple respiratory viruses. Data on the exact metric thresholds that correspond with a higher risk for transmission are lacking. In addition, data from these systems are generally not available for all jurisdictions.

Hospice Special Focus Program Proposal Expected This Summer

The Health Group

The Consolidated Appropriations Act (CAA) of 2021 authorized the Secretary of Health & Human Services to create a Special Focus Program (SFP) which aims to address issues that place hospice beneficiaries at risk for poor quality of care through increased oversight and/or technical assistance. According to CMS, the SFP will help to ensure hospices in the program are held accountable for poor quality of care.

CMS has indicated that a proposal for the structure of the SFP would be included in the home health proposed rules, which is generally issued in mid-summer.

CMS contracted with Abt Associates, Inc. (Abt), an independent research company, to support the development of the hospice SFP. To gain input from key stakeholders on various aspects of the SFP, Abt convened a TEP comprised of a wide range of hospice experts and held four listening sessions with additional stakeholder groups. The TEP and stakeholders opined on the SFP methodology to identify poor performing hospices and other components of the program, including additional oversight and technical assistance to hospices selected for the program to enable continuous improvement.

On April 28, 2023, Abt Associates, Inc. issued their report entitled “2022 Technical Expert Panel and Stakeholder Listening Sessions: Hospice Special Focus Program Summary Report.”  The report is available here. 

The SFP is only one (1) of the many efforts directed at hospice program integrity.  Hospices need to remain aware of developments regarding SFP as well as other current and planned hospice integrity initiatives of CMS.

NAHC Safety Task Force

National Association for Home Care and Hospice (NAHC) and Johns Hopkins Care at Home (JHCH) welcome comments on the drafted home care employee safety guide from NAHC members and other expert individuals.

NAHC Safety Task Force has come together to address the uniqueness and unpredictability of home care worker safety by creating a Call to Action: Protecting our Home Care Employees, a starting point for recommendations within an employee safety plan.

To further strengthen our unified mission and goal to improve employee safety for those working in the home and community, we invite you to participate in an open comment period to share your feedback and recommendations.

The open comment period will occur from May 1, 2023, to June 2, 2023.