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.

Twitter Chat to Discuss Emergency Department Medication for Opioid Use Disorder

To help raise awareness around Emergency Department (ED) Medication for Opioid Use Disorder (MOUD), the MHA will host a Twitter chat from noon to 1 p.m. April 4. During the event, the MHA will post questions from @MIHospitalAssoc, with commentary from the MHA Keystone Center, the Community Foundation of Southeast Michigan (CFSEM) and other members of the Michigan Opioid Partnership. MHA-member hospitals and community organizations are encouraged to share their current initiatives and success stories using the hashtags #MHAHealthChat, #MOUD, and #MAT.

The event follows an announcement of an ED MOUD initiative and funding opportunity for Michigan hospitals launched by the CFSEM in partnership with the MHA Keystone Center, the Michigan Opioid Partnership and the Michigan Department of Health and Human Services. The initiative aims to increase access to evidence-based medication for opioid use disorder and support the transition to long-term, office-based treatment upon discharge. Applications are now being accepted on a rolling basis until April 22. For the most current information, application instructions and grant guidelines, visit the CFSEM website, or contact the MHA Keystone Center to learn more.

Those with Twitter accounts are encouraged to participate in the chat to maximize the spread of information around ED MOUD, as many of these programs help address stigma and increase access to effective treatment for opioid use disorder. Those interested can confirm participation in the chat by contacting Lucy Ciaramitaro at the MHA.

Medication for Opioid Use Disorder Cuts Hospital Costs, Improves Patient Care

The MHA Keystone Center is working alongside the Community Foundation for Southeast Michigan (CFSEM) through the Michigan Opioid Partnership to provide funding and technical assistance for the emergency department-based medication for opioid use disorder (ED MOUD) program. The program will increase access to medication for OUD statewide and connect patients receiving MOUD with appropriate resources to continue care in the community. An online video provides additional information on the program.

The CFSEM recently released impact stories highlighting successes of the program from previous participants. Andrew King, MD, an emergency room physician at Detroit Medical Center and advisor to the CFSEM, has witnessed the effectiveness of MOUD and reminds practitioners that it is possible to guide those with OUD down a path to recovery.

“I can see the people who are now on medications and feeling much better and doing well. They are happy and putting their lives back together, and that’s a beautiful thing!” King says. “By controlling the disease process, maybe they’re treating their kids or their spouse better or they’re doing a better job at work. That’s the whole point of why we signed up for this job — trying to keep people safe and healthy and in the game for as long as possible.” An article from the CFSEM provides additional information.

The MHA has also been advocating to improve legislation related to ED MOUD by working with the Michigan Department of Health and Human Services to ensure all hospitals interested in starting an emergency department-based medication assisted treatment program have the funding resources to do so.

Members with questions on the ED MOUD program may contact the MHA Keystone Center.

Healthcare Bills Progress Prior to State Legislative Summer Break

Dr Roper

Michigan CapitolThe Michigan Legislature continued work on bills impacting Michigan hospitals as it goes into the final week before its summer break. Action was taken during the week of June 21 on issues regarding certified registered nurse anesthetists (CRNAs), the fiscal year (FY) 2022 budget, pharmacy benefit managers (PBMs), requirements for Canadian health professionals in Michigan and allowing certain health professionals to train nurse aides. In addition, the Michigan Department of Health and Human Services held a news conference on legislation related to treatment for opioid use disorder (OUD), and the governor signed legislation related to the Certificate of Need (CON) program.

Both the House and Senate took action on House Bill (HB) 4359, voting to support the important legislation that would modernize the scope of practice for CRNAs. The bill was introduced by Rep. Mary Whiteford (R-Casco Township) and will now go to the governor’s desk for signature. The legislation would bring Michigan in line with 42 other states and the U.S. military, all of which provide flexibility regarding physician supervision of CRNAs delivering anesthesia care. The MHA has supported HB 4359 with testimony in both chambers and will continue to advocate for the bill to be signed into law.

Representatives in the House approved House Bill (HB) 4410, which would provide for all funding for the FY 2022 budget year, aside from community colleges and higher education. HB 4410 would protect key hospital priorities, including graduate medical education, disproportionate share hospital funding, rural and obstetrics stabilization pools, critical access hospital funding and Medicaid rate increases. The bill includes new provisions that would make changes to streamline prior authorization timeframes for Medicaid health plans and boilerplate that would prohibit the use of any funds for vaccinations under a mandatory vaccination program. Due to concerns that the vaccine mandate provision could hinder state vaccination efforts, the MHA will work closely with the administration to address potential issues. HB 4410 will now be sent to the Senate for consideration.

The House Health Policy Committee reported Senate Bill (SB) 416 to the floor. The bill was introduced by Sen. Wayne Schmidt (R-Traverse City) and would ensure that Canadian health professionals who have previously taken relevant medical exams could apply for Michigan licensure. SB 416 clarifies legislation supported by the MHA during the last session that provided licensure reciprocity to Canadian health professionals who want to work in Michigan. It will now be sent to the full House for a vote.

The House Health Policy Committee also took testimony on HB 5089, which was introduced by Rep. Ann Bollin (R-Brighton Township) and would allow a registered professional nurse to train nurse aides without a permit for up to four months after the end of the COVID-19 declared state of emergency. The MHA has not taken a position on HB 5089 and no vote was held.

In the Senate Health Policy and Human Services Committee, further testimony was held on HB 4348, which would regulate and establish licensure for PBMs in Michigan. The legislation was introduced by Rep. Julie Calley (R-Portland) and is supported by the MHA to help slow the rising cost of prescription medications. No vote was held in committee on HB 4348.

Dr. Daniel Roper participated in the June 23 event that announced legislation to increase access to lifesaving treatment for opioid use disorder.A news conference was held June 23 to announce the introduction of a bill that would provide funding for a grant program for hospitals to increase access to medication assisted treatment for OUD in the emergency department (ED). The MHA Legislative Policy Panel supports the bill, which is intended to increase access to lifesaving treatment for OUD. Daniel Roper, MD, chief of emergency services and medical director of the ED at Mercy Health Saint Mary’s in Grand Rapids, represented one of 19 Michigan hospitals currently providing medications for OUD in EDs during the event, noting that the proposed bill would remove barriers for other providers to offer the treatment. The bill is expected to be introduced before the legislative summer break, and the MHA will keep members apprised of its movement.

Lastly, the governor signed SB 440 into law June 24 as Public Act 35 of 2021. SB 440 was introduced by Sen. Winnie Brinks (D-Grand Rapids) and would remove full-body PET scanner services from CON oversight.

Members with questions on these or other state legislative issues should contact Adam Carlson at the MHA.