State & Federal Requirements
Frequently Asked Questions
DEA Requirements
Sec. 1263 of the spending bill Congress passed in December 2022 requires controlled substance prescribers to complete 8 hours of one-time training on safe controlled substance prescribing as a condition of receiving or renewing a DEA registration.
What is the requirement you ask? The statutory language is provided by a separate bill, called the Medication Access and Training Expansion Act (or MATE Act).The MATE Act will better equip the health care system to identify, treat, and prevent addiction, as well as improve pain management by educating providers, addressing racial bias, and standardizing training nationwide.
Does this new DEA training requirement affect me?
Likely. The requirement applies to all DEA registration submissions (Schedules II, III, IV, and V)—regardless of whether it is an initial registration or a renewal registration—beginning on or after June 27, 2023. The only exceptions are veterinarians and those who will not be obtaining or renewing a DEA registration.
What am I required to do?
At the time of your next scheduled DEA registration submission (but not before June 27, 2023), registrants must: • Complete eight hours of qualified training on safe controlled substance prescribing. • Check a box on your registration submission affirming that you have completed required training. • Retain copies of all certificates of completion. This applies regardless of whether a registrant is completing their initial registration application or renewing their registration. It also applies to all drug schedules (Schedules II, III, IV, and V).
What is the deadline for satisfying this new training requirement?
•Compliance is required by the time of your next scheduled DEA registration submission— regardless of whether it is an initial registration or a renewal registration—but not before June 27, 2023. For example, if you renew on June 26, 2023, compliance is not required until the next renewal. •This one-time training requirement affirmation will not be a part of future registration renewals
How can I satisfy this new training requirement?
Physicians (MD/DO) and other practitioners can satisfy this training by engaging in a total of eight hours of training on treatment and management of patients with opioid or other substance use disorders from the approved organizations listed below. A few key points related to this training: 1. The training does not have to occur in one session. It can be cumulative across multiple sessions that equal eight hours of training. 2. Past trainings on the treatment and management of patients with opioid or other substance use disorders can count towards a practitioner meeting this requirement. In other words, if you received a relevant training from one of the organizations listed below— prior to the enactment of this new training obligation on December 29, 2022—that training counts towards the eight-hour requirement. 3. Past DATA-Waived trainings count towards a DEA registrant’s 8-hour training requirement. 4. Trainings can occur in a variety of formats, including classroom settings, seminars at professional society meetings, or virtual offerings. Important Items to Note: To qualify, the coursework must meet three criteria: • The course must be an approved topic • The course must be conducted through an approved medium • The course must be delivered by an approved training provider
Does the FAFP offer eligible training on safe controlled substance prescribing?
Yes. The FAFP offers a 2-hour online enduring material course on controlled substance prescribing, and the new federal law specifies that relevant courses offered by the providers will satisfy the requirement. This 2-hour course include CME credit and is free for FAFP members. Note: Past DATA-Waiver trainings count towards a DEA registrant’s 8-hour training requirement. Important: Before taking new courses, note that past trainings from recognized organizations can be used to satisfy requirement. In other words, if you received a relevant training from one of the recognized organizations—prior to the enactment of this new training obligation on December 29, 2022—that training counts towards the eight-hour requirement. DEA has confirmed there is no statute of limitations for past coursework to qualify.
How will DEA enforce this requirement?
DEA has indicated it does not plan to audit or investigate prescribers based solely on compliance with this training requirement. However, the agency may check for certificates of completion when investigating a prescriber for some other infraction.
How do I demonstrate compliance?
Registrants will need to check a box on their DEA registration submission—regardless of whether it is an initial registration or a renewal registration, affirming they have completed the required training. Prescribers should retain copies of all certificates of completion. Recent graduates should contact their medical school for completion certificates, but they will also need to take supplemental training if their qualifying medical school courses total less than eight hours. The DEA currently has no plans to create a platform that will allow prescribers to upload and store certificates of completion.
Will I have to complete the eight hours of training on a cyclical basis?
No. Additional training is not required after the one-time, 8-hour requirement has been satisfied. Sec. 1263 specifically states, “The Attorney General shall not require any qualified practitioner to complete the training…more than once.”
Do recent medical school graduates have to complete this additional training?
Likely. The requirement applies to all DEA registration submissions—regardless of whether it is an initial registration or a renewal registration—beginning on or after June 27, 2023. If you do not intend to apply for a DEA registration, you are not affected.
Do the trainings have to be for continuing education credit?
No. Certificates of completion are required, but formal continuing education credit is not.
I have multiple DEA registrations. Do I have to complete eight hours of training for each one?
No. The same eight hours of training can be recycled for multiple DEA registrations
Do I have to use specific training providers?
Yes. The course(s) must be provided only by the organizations listed in the statute. Training must be provided by or approved by one of the following organizations: 1. The American Society of Addiction Medicine 2. The American Academy of Addiction Psychiatry 3. The American Medical Association 4. The American Osteopathic Association 5. The American Dental Association 6. The American Association of Oral and Maxillofacial Surgeons 7. The American Psychiatric Association 8. The American Nurses Credentialing Center 9. The American Association of Nurse Practitioners 10. The American Academy of Physician Associates 11. Any other organization accredited by the Accreditation Council for Continuing Medical Education (ACCME) or the Commission for Continuing Education Provider Recognition (CCEPR) 12. Any organization accredited by a State medical society accreditor that is recognized by the ACCME or the CCEPR 13. Any organization accredited by the American Osteopathic Association to provide continuing medical education 14. Any organization approved by the ACCME, or the CCEPR
Will training completed prior to the law’s passage count toward the new requirement?
Yes. Past trainings from designated training organizations can count towards a practitioner meeting this requirement. In other words, if you received a relevant training from one of the recognized organizations—prior to the enactment of this new training obligation on December 29, 2022—that training counts towards the eight-hour requirement. DEA has confirmed there is no statute of limitations for past trainings to satisfy the requirement. Certificates of completion are required.
Does the eight hours of training have to occur in one session?
No. The training does not have to occur in one session. It can be cumulative across multiple sessions that equal eight hours of training.
How does the removal of Data Waiver (X-Waiver) affect me?
To learn about the Removal of DATA Waiver (X-Waiver) Requirement, click here.
How does the removal of Data Waiver (X-Waiver) affect me?
For outside resources related to treatment and management of patients with opioid or other substance use disorders, click here.
Telehealth After COVID-19
Frequently Asked Questions
Is telehealth going away after the Public Health Emergency (PHE) ends?
No, but many changes occurred in 2023, and more changes are coming. Most telehealth encounters still require BOTH audio and video. Legislators continue to strongly support permanent telehealth coverage for mental health disorders, for substance abuse disorders, and for rural areas. Payment parity (same reimbursement as in-person care) is unlikely once temporary policy flexibilities and extensions expire.
Can I provide telehealth to patients out of state?
No (generally). Providers must be licensed in the state the patient is physically in at the time of the telehealth service. Telehealth policies widely vary state-by-state.
Can new patients continue to be seen via telehealth?
It depends on the telehealth modality. Virtual check-ins and Remote Patient Monitoring (RPM) can only be used for established patients. New patients can be seen via virtual office visits temporarily, but there are now stricter in-person requirements for controlled substances.
Can I prescribe new controlled substances via telehealth?
Only if an in-person evaluation has been done by the provider beforehand, for schedule II-V drugs. However, qualifying practitioners can prescribe buprenorphine to new and existing patients with opioid use disorder based on a telephone evaluation.
Can I refill a controlled substance via telehealth for an established patient?
•Under certain conditions. The DEA has temporarily expanded PHE flexibilities for schedule II-V controlled substances until Nov. 11th, 2024 (for patients established with providers prior to Nov. 11, 2023). After that date, Schedule II drugs like Vicodin, OxyContin, Adderall, and Ritalin will require an in-person visit before they can be prescribed virtually, and Schedule III-V drugs like codeine, Xanax, Ambien, and buprenorphine can only be prescribed for an initial 30-day period. After the initial 30-days, a patient will need to see the doctor in-person once to get a refill. •Florida law SB 312 permanently allows for prescribing schedule III-V drugs via telehealth in Florida, but prohibits prescribing Schedule II controlled substances unless an exception is met: 1. The treatment of a psychiatric disorder 2. Inpatient treatment at a hospital licensed under chapter 20 395 3. The treatment of a patient receiving hospice services as defined in s. 400.601 4. The treatment of a resident of a nursing home facility as defined in s. 400.021
Will I continue to be paid the same for a telehealth visit as an in-office visit?
•No. Traditional Medicare B will continue to pay the same rate through Dec. 31st, 2023. All other payers will begin reducing reimbursement after May 11th, 2023 (end of PHE). •For Medicare patients until Dec 31st, 2023, providers should use the place of service (POS) that would have been used if the patient was seen in person rather than POS 02 telehealth. If the patient would have been seen in the office, using POS 11 results in a higher non-facility payment (same as in office). If POS 02 is used, it results in a lower payment, at the facility rate.
Can my patient continue to be at home for a telehealth visit, regardless of whether they live in a rural or urban location?
For Medicare patients only for now, until Dec. 31, 2024, as stated in the Consolidated Appropriates Act (CAA) of 2023. Commercial insurance companies are not required to follow this policy, and so they may not permit a patient’s home to be an “originating site”.
Can I continue to do Medicare Annual Wellness Visits via telehealth?
For now, until Dec. 31st, 2024. In the CY 2023 Final Rule, CMS defined temporarily available telehealth services, with the extension timeframe enacted by the CAA of 2023, further extending flexibilities through CY 2024.
Will I still be reimbursed for audio-only patient encounters (phone calls) ?
•For most payers - No, and for Medicare, yes temporarily. CMS will pay for audio only telehealth until Dec. 31, 2024, at the same rate as office visits using codes 99441-99443. The AMA has developed a new modifier, -93 for audio only services. Medicare is requiring its use in 2023. •Congress passed a law in 2020 mandating that after the PHE ends, behavioral health services will continue to be allowed via telehealth, audio/visual AND audio only.
Can I still perform telehealth visits from my home?
Under certain conditions. After Dec. 31st, 2023, if a provider wishes to perform telehealth visits from home, he or she is required to report a home address on the Medicare enrollment site.
Can I continue to use Doximity to provide telehealth services?
Yes. Telehealth platforms must be HIPAA compliant, which includes companies like Doximity, Zoom for Healthcare, Doxy.me, ThinkAndor, GoToMeeting, and others. Apple FaceTime is not currently HIPPA compliant.
Can residents and fellows still participate in telehealth services?
Under certain conditions. Virtual supervision is no longer allowed in metropolitan areas, although CMS is allowing virtual supervision of residents until Dec. 31, 2023. The attending must be in the same physical location as the resident/ fellow. Level 4 and higher visits require an attending physician to “see” the patient for sites under the primary care exception (resident has been with primary care training program for at least 6 months).
References
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https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/covid-phe-end-telehealth.html
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https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
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https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates
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Telehealth after the COVID-19 PHE: What's changing and what's staying the same for now
Human Trafficking Poster Available
In May, the Florida Legislature passed HB 851 "Human Trafficking" which mandates physicians prominently display a poster in the physician/provider’s office by January 1, 2020, and to complete a one-time, one-hour, board of medicine approved mandatory CME requirement by January 1, 2021. The FAFP designed a poster for FAFP members to utilize and is both downloadable and available for pick-up at FAFP weekend meetings. FAFP members can print the poster on-demand (CLICK HERE), but make sure the size is at least 11"x17" as required by law. While CME for human trafficking is no longer mandated, the FAFP ensures information regarding this important topic by other mandatory CME programs presented by the Academy annually. For more information, please visit the Florida Department of Health website by clicking here.
Florida Opioid Prescribing Legal Requirements
Telehealth Legislation Passed (F.S. 456.0301)
Effective July 1, 2018, legislation was passed and the boards of medicine subsequently adopted administrative rules establishing guidelines for prescribing controlled substances for the treatment of acute pain. Issues addressed include the evaluation of the patient, creation, and maintenance of a treatment plan, obtaining informed consent and agreement for treatment, periodic review of the treatment plan, consultation, medical record review, and compliance with controlled substances laws and regulations. The Florida Department of Health's Take Control of Controlled Substances website provides a comprehensive guide to the rules and regulations physicians must follow to remain in compliance.
Telehealth Prescribing Statute (F.S. 456.47)
Section 456.47, Florida Statutes (approved 2019), establishes the telehealth practice standard for physicians (MD/DO). Three years later in 2022 this telehealth statute was updated allowing Schedule III, IV, and V controlled substances to be prescribed via telehealth. It is important to note, a physician providing telehealth services may not use telehealth to prescribe a controlled substance listed in Schedule II of F.S 893.03 unless the controlled substance is prescribed for the following:
1. The treatment of a psychiatric disorder;
2. Inpatient treatment at a hospital licensed under chapter 395;
3. The treatment of a patient receiving hospice services
4. The treatment of a resident of a nursing home facility
Mandatory 2-hour FAFP Members*
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