Cynthia B. Jones                                                                                                             March 7, 2017

Director

Department of Medical Assistance Services

600 E. Broad Street, Suite 1300

Richmond, VA 23219

RE: Draft Addiction and Recovery Treatment (ARTS) Services Regulations

Dear Director Jones:

On behalf of the Medical Society of Virginia (MSV), thank you for the opportunity to provide feedback to the Department of Medical Assistance Services (DMAS) on the development of Addiction and Recovery Treatment Services (ARTS) Regulations.  MSV appreciates the continued attention to addiction treatment by DMAS and applauds the development of these regulations.  After considering the draft regulations, we believe the following considerations to the regulations will provide additional clarity and bring the regulations in line with the recently approved Board of Medicine Regulations Governing Prescribing of Opioids and Buprenorphine.  Aligning both sets of regulations will reduce confusion and allow physicians to apply uniform requirements for addiction treatment to all patients, in lieu of a fragmented set of rules that may lead to unintentional incompliance and diminished patient care. 

Use of Credentialed Addiction Treatment Professionals

MSV supports the use of highly qualified professionals to deliver counseling.  However, due to the current shortage of licensed counselors, MSV recommends allowing for ‘mental health service providers’ as defined by § 54.1-2400.1 of the Code of Virginia for situations in which a ‘credentialed addiction treatment professional’ is unavailable.  This would expand the regulations to reflect the inclusion of mental health services providers in the Board of Medicine Regulations on opioids and buprenorphine prescribing.  Including mental health service providers will expand patient access to counselors while maintaining high qualifications. 

MSV also recommends providing clarified definitions for other counseling categories referenced in the regulations: licensed treatment professional and licensed behavioral health provider.

Clarify Practice Collaboration Agreements

MSV recommends altering the definition of “office-based opioid treatment” to reflect the BOM regulatory language:

Office-based opioid treatment" or "OBOT" means addiction treatment services for individuals with moderate to severe opioid use disorder provided by buprenorphine-waivered practitioners who refer or consult working in collaboration with credentialed addiction treatment practitioners providing psychosocial counseling in public and private practice settings.

Additionally, MSV recommends providing additional clarifications on requirements for physician assistants and nurse practitioners:

"Buprenorphine-waivered practitioners" means health care providers licensed under Virginia law and registered with the Drug Enforcement Administration (DEA) to prescribe Schedule III, IV, or V medications for treatment of pain. Physicians shall have completed the buprenorphine waiver training course and obtained the waiver to prescribe or dispense buprenorphine for opioid use disorder required under the Drug Addiction Treatment Act of 2000 (DATA 2000). They shall have been issued a DEA-X number by the DEA to prescribe buprenorphine for the treatment of opioid use disorder. Practitioners who are not physicians Physician assistants and nurse practitioners must obtain a SAMSHA waiver and shall only prescribe buprenorphine for opioid addiction pursuant to a practice agreement with a waivered doctor of medicine or doctor of osteopathic medicine. meet all federal and state requirements and be supervised by or work in collaboration with a qualifying physician who is buprenorphine waivered.

Prescription Monitoring Program

MSV suggests including a reference to § 54.1-2522.1 of the Code of Virginia in all mentions of the requirements to query the PMP to ensure the regulations reflect current law.  Additionally, MSV recommends reflecting the requirements of the BOM regulations, instead of including specific quarterly query requirements.  

Urine Drug Screens

MSV recommends two changes regarding urine drug screens with the intention to align with the requirements included in BOM regulations.  First, include an option for a blood serum medication level test in lieu of a urine test.  Blood serum medication levels may be a more appropriate indicator in some circumstances.  Second, align the frequency required to reflect the BOM regulations: at least every 3 months for the first year and at least every 6 months thereafter. 

In addition to these concerns, we would encourage DMAS to include updates that will ensure consistency in all processes that run parallel to the Board of Medicine Opioid and Buprenorphine regulations, including requirements for prior authorization, treatment plan documentation, and naloxone distribution.  Thank you for your consideration of the above suggestions.  MSV continues to appreciate the contribution of DMAS and the ARTS program to addressing addiction in Virginia.  Please contact Julie Galloway, MSV Health Policy Analyst, if we may be of assistance.

Sincerely,

Lauren Bates Rowe

Assistant Vice President of Health Policy

CC: Kate Neuhausen, MD, MPH, Chief Medical Officer, Department of Medical Assistance Services               

Emily McClellan, Regulatory Supervisor, Department of Medical Assistance Services

David Brown, D.C., Director, Department of Health Professions

Elaine Yeatts, Policy Analyst, Department of Health Professions

Melina Davis-Martin, Executive Vice President, MSV

Scott Johnson, General Counsel, MSV

Lauren Bates-Rowe, Assistant Vice President of Health Policy, MSV

Ralston King, Assistant Vice President of Government Affairs, MSV