WISAM On-Demand Recordings
ASAM | Addiction Policy News
The new policy exempts eligible, DEA-registered practitioners from federal certification requirements related to training, counseling, and other ancillary services that are part of the process for obtaining a waiver to treat up to 30 patients with buprenorphine – a step toward helping Americans with opioid use disorder access evidence-based addiction care
Rockville, MD - The American Society of Addiction Medicine (ASAM) applauds steps to reduce barriers to patients accessing medications for opioid use disorder (OUD), including today’s announcement from the U.S. Department of Health and Human Services (HHS) on Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder, which were posted for public inspection in the Federal Register today.
“The guidelines released by HHS create exemptions from enumerated X-waiver certifications with respect to certain practitioners prescribing buprenorphine for opioid use disorder, an important step toward improving our patients’ access to this medication,” said Dr. William Haning, president of ASAM. “We now look to Congress to take critical and necessary next steps, including securing a permanent elimination of buprenorphine-specific training requirements, patient limits, and DEA audits, as well as the separate X-waiver application, for DEA-registered prescribers, while ensuring these clinicians receive baseline training on treating patients with substance use disorder.”
From 1999 to 2017, nearly 400,000 people in the United States died from overdoses related to opioids – due in part to a critical misunderstanding of the substantial evidence for the safety and effectiveness of medications that treat OUD, as well as the historical separation of addiction treatment from mainstream medical care.
Specifically, the new HHS practice guidelines exempt eligible, DEA-registered practitioners from the certification requirements under 21 U.S.C. §823(g)(2)(B)(i)-(ii). The exemption, however, is subject to the limitations of the guidelines. For example, a practitioner utilizing this exemption will still be required to obtain a waiver by submitting a Notice of Intent to the Substance Abuse and Mental Health Services Administration before treating patients with buprenorphine for OUD. Such a practitioner also will be limited to treating no more than 30 patients with buprenorphine for OUD at any one time, and time spent practicing under the exemption will not qualify the practitioner for a higher patient limit. Finally, while these guidelines change certain federal requirements, they do not govern possible state requirements that may be applicable.
ASAM notes that an elimination of the X-waiver should be combined with needed education about the identification and treatment of substance use disorder in patients seen in daily practice. Proper education increases clinicians’ willingness to administering life-saving, addiction care. ASAM commends HHS for recognizing that substance use disorder education is not yet uniformly integrated into medical education and that colleges of medicine and training programs are strongly encouraged to develop or to continue implementing comprehensive training in substance use disorder diagnosis and management as a component of their core, required curriculum.
“While the ongoing COVID-19 pandemic has wrought havoc on all, it has particularly jeopardized the health of vulnerable populations, including the more than 20 million Americans living with substance use disorder,” said Dr. Haning. “An elimination of the X-waiver coupled with increased addiction training has the potential to save thousands of lives and free DEA-registered prescribers of unnecessary barriers that have too long impeded them from helping their patients.”
WMS | Medigram
The Wisconsin Medical Society (Society) honored the accomplishments and contributions of two outstanding physicians during the Board of Directors meeting held virtually on April 17. The 2021 Director’s Award and Presidential Citation were presented to honor physicians who have made a difference to the Society and the profession of medicine.
The Director's Award was presented to Michael Miller, MD, Madison. Established in 1928, this award is the Society’s highest honor, given to recognize outstanding physicians who have served the medical profession with integrity and honor and who have made numerous and substantial contributions to the profession and the community.
Throughout his career, Dr. Miller has been involved with the Society in many ways, most notably as Speaker. Dr. Miller has also had longstanding commitment as an AMA Delegate/Alternate along with involvement in the AMA Council on Science and Public Health. He has also served as President and Board Chair of his national specialty society (ASAM), President and Board Chair of his county medical Society (Dane County) and as a Director of his specialty board (ABAM).
The Presidential Citation was presented to Ryan Westergaard, MD, PhD, MPH, Madison. The award was established in 1959 to recognize an individual who has made a significant contribution to medicine and to the public’s health.
Dr. Westergaard is the current Chief Medical Officer and State Epidemiologist for the Bureau of Communicable Diseases, Division of Public Health, at the Wisconsin Department of Health Services. Dr. Westergaard has been honored for his leadership in addressing the pandemic of the SARS-CoV-2 virus, exhibited by his communication with both Public Health Agencies and physicians, keeping them abreast of the most current scientific evidence, guidance and resources.
April 6, Wisconsin Health News
The premium holiday for Wisconsin’s medical malpractice fund will continue until mid-2022 to help offset impacts on providers from COVID-19.
Insurance Commissioner Mark Afable notified the Joint Finance Committee last week that he’s requesting that fiscal year 2022 rates for healthcare providers participating in the Injured Patients and Families Compensation Fund remain the same as the current fiscal year, which ends June 30.
The committee has until April 15 to approve the request. Currently, the fund is waiving fees for participating healthcare professionals and providers, per a request from the Wisconsin Medical Society. The premium holiday is set to last until June 30, 2022.
OCI spokeswoman Sarah Smith said that the rates will remain the same because the fund won’t be charging due to the COVID-19 pandemic.
Mark Grapentine, chief policy and advocacy officer at the Wisconsin Medical Society, said independent clinics are still fighting COVID-19 related costs and lost revenue and keeping the status quo for now makes sense.
“We’re doing all we can to advocate for those independent clinics who provide such important care to their communities while being on the front lines of the pandemic,” he said in an email. “We’re very fortunate to have a fund that’s run prudently and is in a stable financial condition so that it can provide a little fiscal relief for physicians.”
The Injured Patients and Families Compensation Fund covers claims beyond state-mandated insurance limits, which are set at $1 million by occurrence and $3 million by aggregate annually.
The State of Wisconsin’s Medical Examining Board (MEB) at its most recent monthly meeting advanced a proposed administrative rule that will extend for another biennium the requirement that most physicians obtain two credits of continuing education related to opioid prescribing. The requirement applies to physicians who hold a Drug Enforcement Administration registration number, with the two credits being part of the 30 credits required each biennium. Courses must be approved by the MEB in order to satisfy the subject matter requirement.
The Wisconsin Medical Society (Society) spoke in favor of the rule at the MEB public hearing March 17, noting how the COVID-19 pandemic has exacerbated opioid abuse across the county. The Society also expressed appreciation that the rule widens the scope of qualifying coursework beyond opioid prescribing to include “other controlled substances.” This will allow physicians who hold a DEA number but may not prescribe opioids to access coursework more relevant to their practice.
The MEB also began to discuss whether to add a provision to the “unprofessional conduct” section of the MEB’s administrative code (MED 10) that could require physicians to offer patients a chaperone for certain sensitive physical exams. The idea comes from a January 2020 ACOG Community Opinion paper recommending that a chaperone be present for all breast, genital and rectal examinations. While the MEB discussed the issue only generally during its meeting March 17, it will review potential language at its April meeting.
Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.
Wisconsin Doctor Day - May 5, 2021
Opening Keynote Address Featuring AMA President, Susan R. Bailey MDDr. Susan R. Bailey, a distinguished allergist/immunologist from Fort Worth, Texas, is the 175th president of the American Medical Association. Doctor Bailey's presentation, What Will Healthcare Look Like Post COVID-19?, will touch on delivery of care, rebounding from physician stress, and the impact of the pandemic on the physician workforce.
Click here for more information!
The Wisconsin Society of Addiction Medicine will begin the third year of hosting the X-Waiver Training Series with the first training available on March 5, 2021. WISAM partners with the Wisconsin Department of Health Services in order to offer these trainings for FREE to all Wisconsin providers who are eligible to prescribe buprenorphine. The partnership continues with the American Society of Addiction Medicine in order to provide the ASAM Treatment of Opioid Use Disorder Course (TOUD).
This series is designed to increase treatment capacity for opioid use disorders by training more prescribers to be able to treat opioid use disorders with buprenorphine. This live course has been approved by the Wisconsin Medical Examining Board as meeting the requirements for the two-hour continuing education course on responsible opioid prescribing per Med 13.03(3) of the Wisconsin Administrative Code.
The course involves 4 hours of online training paired with 4 hours of in-person training. The self-paced online course will be available through ASAM’s website upon registration.
This course is open to MDs, DOs, NPs, and PAs. MDs and DOs must complete the full 8-hour course to be eligible for their DATA Waiver. NPs and PAs must complete the full 8 hour course, plus 16 additional hours provided free by ASAM (contact email@example.com about registering for the additional 16 hours.) Medical students and NP and PA students are eligible to take the course, but will not be eligible to apply for their waiver. Eligible providers who do not yet hold DATA Waivers are particularly encouraged to attend, but Waiver-holding providers can also attend for CME credit. You must attend the entire course to qualify for CME credit.
Click here to view the full schedule
Wisconsin Health News
Wisconsin has received a grant to help develop an implementation plan for 988, a new calling code that will launch next year for the National Suicide Prevention Lifeline.
The $171,701 grant from Vibrant Emotional Health, the administrator for the national lifeline, will fund a coalition organized by the Department of Health Services to establish a system to ensure everyone in the state has direct access through the number to trained counselors.
“A three-digit calling code will open the door for more people to seek the help they need, while sending the message that healing, hope and help are happening every day,” said DHS Interim Secretary Karen Timberlake.
The new calling code is expected to launch July 2022. The coalition will start meeting in April, with a goal of having a draft of the plan completed by August and the final plan by the end of the year.
Grants states power to restart Medicaid services for incarcerated individuals 30 days before their release
WASHINGTON, D.C. – U.S. Senators Tammy Baldwin (D-WI), Mike Braun (R-IN), Sheldon Whitehouse (D-RI) and Sherrod Brown (D-OH) are leading the Senate introduction of the bipartisan Medicaid Reentry Act, legislation expanding access to addiction treatment and other health services for Medicaid-eligible individuals 30 days before their release from jail or prison. The bipartisan legislation is also being re-introduced in the House of Representatives by Congressmen Paul Tonko (D-NY-20) and Michael Turner (R-OH-10).
Currently, federal statute prohibits any form of federal health coverage for incarcerated individuals except under very limited circumstances. In most states, Medicaid coverage is immediately terminated when someone is sent to a correctional setting. This creates a serious coverage gap when individuals are released, as they often have no access to health care or addiction treatment during a stressful and dangerous time. This bill is a bipartisan response to this issue, following alarming evidence published in the New England Journal of Medicine that individuals reentering society are 129 times likelier than the general population to die of a drug overdose during the first two weeks after release.
“The opioid and substance use disorder epidemic remains rampant in Wisconsin and across the country, and the ongoing COVID-19 pandemic is dramatically impacting the addiction prevention, treatment, and recovery landscape in this country. This problem is harshly affecting incarcerated individuals who are working to reenter society, but currently lack the health care coverage they need to continue their recovery,” said Senator Baldwin. “We need to make sure these rehabilitated folks have Medicaid or other health care coverage needed to seamlessly transition back to community care, and reduce the risk of overdose deaths post-release. I’m proud to work with my Senate and House colleagues on this bipartisan reform to address our nation’s addiction crisis and support our continued fight against this deadly epidemic.”
Washington Post | By Dan Diamond and Lenny Bernstein
The Biden administration is preparing to halt a last-minute plan by the Trump administration to let more physicians prescribe an opioid-treatment drug, said three officials with knowledge of the pending announcement, who spoke on the condition of anonymity because they were not authorized to discuss the plan.
The Trump plan had been hailed by physicians as loosening requirements they said had slowed their response to the nation’s worsening opioid crisis. Then-presidential candidate Joe Biden also criticized the prescribing rules and vowed to lift them if elected president. But some legal experts warned that the Department of Health and Human Services lacked the authority to issue guidelines that allowed physicians to avoid requirements mandated by Congress.
“Unfortunately, the Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder announced by the Trump administration in its last days had significant legal and clinical concerns,” according to a draft announcement obtained by The Washington Post. “The Biden Administration will not issue the Guidelines previously announced.
The previously announced, Trump Administration, HHS practice guidelines regarding a new exemption from certain X-waiver certification requirements for certain physicians never posted to the Federal Register-- which means the exemption never went into effect. The Biden Administration has put a temporary freeze on matters not yet posted to the Register, pending further review. As soon as ASAM receives further information from federal agencies about all of this, we will inform our members.
In the meantime, on Capitol Hill, ASAM continues to advocate for a complete elimination of the X-waiver while ensuring controlled medication prescribers have baseline education on addiction – that will require a legislative “fix.”
We have some important news to share regarding buprenorphine prescribing from HHS. For physicians, the requirement for a separate X-Waiver to prescribe Buprenorphine/naloxone will no longer be required. The patient limit for physicians without the X-Waiver will be 30 patients but it is unclear at this time what it will mean for X-waived providers. This does not apply to PA's or NP's. ASAM plans to put out a statement in the next few days when more details are available.
David Galbis-Reig, M.D., DFASAM
President, Wisconsin Society of Addiction Medicine
HHS Expands Access to Treatment for Opioid Use Disorder