DEA Change in X-Waiver Requirement

President Biden approved the elimination of the DATA Waiver (X-Wavier) requirement and several other prescribing practice changes when he signed Dec. 29 the Consolidated Appropriations Act, 2023. Changes to prescribing practices include:

  • No longer requiring the X-Waiver to treat patients with buprenorphine for opioid use disorder.
  • Removing any limits or caps on the number of patients a prescriber may treat with buprenorphine for opioid use disorder.
  • Only requiring a standard Drug Enforcement Administration registration number for all prescriptions for buprenorphine moving forward.
  • Maintaining existing state laws or regulations that may be applicable.
  • Introducing new training requirements for all prescribers that are expected to take effect June 21, 2023. These requirements have not yet been made clear, but do not impact the elimination of the X-Waiver.

Biden held an event at the White House Jan. 24 celebrating the policy change as a bipartisan success that will increase access to medication for opioid use disorder. The additional barriers the X-Waiver presented deterred providers from offering these services and a similar license was never required for prescribing other controlled substances like opioids.

Current laws and regulations in Michigan have not changed because of the changes to federal X-Waiver requirements, but the Michigan Department of Licensing and Regulatory Affairs (LARA) is in the process of revising substance use disorder (SUD) rules that would no longer require a SUD program license for buprenorphine providers. The Michigan Public Health code currently states:

  • A substance use disorder services program license is required if a prescriber is providing buprenorphine treatment to more than 100 individuals OR is providing methadone treatment.
  • No license is needed if a prescriber is administering buprenorphine treatment to less than 100 individuals at a time.

Michigan’s current rules and regulations regarding prescribing buprenorphine are available on the LARA Substance Abuse Program Licensure webpage.

Members will be updated once the revised SUD rules are approved by the Michigan Joint Committee on Administrative Rules. Updated federal information will be available on the Substance Abuse and Mental Health Services Administration website.

Members with questions should contact the MHA Keystone Center.

Medicare Home Health Prospective Payment System Updated for 2022

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service prospective payment system for home health (HH) agencies effective Jan. 1, 2022. Key aspects of the final rule include:

  • A one-year delay, until Jan. 1, 2023, of the proposed national expansion of the HH value-based purchasing model to replace the pilot that began in nine states (Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington) in 2016.
  • A 6.9% increase to the national, standardized 30-day period payment rate HH band from $1,901.12 to $2,031.61 for HH agencies that submit the required quality data.
  • Recalibration of the Patient-driven Groupings Model (PDGM) case-mix weights for the 432 payment groups, using 2020 data.
  • Modification of the HH quality reporting program measures to:
    • Remove an OASIS-based measure: the Drug Education on All Medications Provided to Patient/Caregiver During All Episodes of Care measure.
    • Replace two claims-based measures — the Acute Care Hospitalization During the First 60 Days of Home Health (NQF #0171) measure and the Emergency Department Use without Hospitalization During the First 60 days of Home Health (NQF #0173) measure — with one claims-based measure — the Home Health Within Stay Potentially Preventable Hospitalization measure.
  • Continuation of the 4.36% behavioral adjustment that was implemented in 2020 when the new PDGM case-mix classification system was implemented.
  • Finalization of the proposal to make permanent the blanket waiver related to virtual supervision of home health aides that was granted temporarily for the duration of the COVID-19 pandemic.
  • Implementation of a provision of the Consolidated Appropriations Act that would allow occupational therapists to perform the initial and comprehensive patient assessment.
  • Continuation of the 4.36% payment cut to the standardized 30-day payment rate implemented in 2020 when the new PDGM was adopted.

The CMS continues to review input received on the agency’s plans to define digital quality measures for the HH quality reporting program and the potential use of fast healthcare interoperability resources in support of digital quality measurement. The MHA will provide members with an updated estimated impact analysis soon. Members with questions should contact Vickie Kunz at the MHA.