AAPS Comments to HHS on Proposed Rules for Treatment of Opioid Use Disorders


Regulatory Information Number (RIN) 0930-AA22

Re: SAMHSA proposed rule entitled Medication Assisted Treatment for Opioid Use Disorders


Physicians and their patients would be adversely affected by this Proposed Rule in several ways.

First, the Proposed Rule attempts to require physicians to accept third-party payment. Proposed Rule § 8.615(e). Many physicians, in increasing numbers, decline to accept third-party payment because of its destructive effect on the patient-physician relationship, as well as the unsupportable administrative costs. Despite or because of the Affordable Care Act (ACA), many patients do not have insurance coverage. It is a violation of basic rights to deny medical care to patients because they cannot afford or choose to forgo third-party payment.

Second, the Proposed Rule improperly coerces physicians to use Electronic Health Records (“EHR”). Proposed Rule § 8.615(c). Often paper medical records are less expensive, more accurate, and more protective of patient privacy than EHRs. There is no justification for the Proposed Rule to force EHRs on physicians and patients.

Third, Agency Questions for Comment #3 (“Practitioner Training for 200 Patient Limit”) and #4 (“Alternate pathways to qualify for 200-patient prescribing limit”) propose that physicians should be board certified in addiction psychiatry or addiction medicine in order to qualify for the higher 200-patient prescribing limit outside of a qualified practice setting. “[T]his means that only practitioners with subspecialty board certifications will be eligible to apply for a patient waiver of 200 and practitioners satisfying training requirements via the other pathways for the 30 and 100 patients will not be eligible ” But this board certification condition simply enriches a private entity that controls board certification without any political accountability or transparency. There is no evidence that it improves care, but it does make it more costly. Such care needs to be more available as the number of patients who need it is increasing.

Unless the above three points are addressed and revised accordingly in the Proposed Rule, it will hinder medical care for patients. Please acknowledge these defects in the Proposed Rule and correct them accordingly before issuing a final rule.

Jane M. Orient, M.D.
Executive Director, of the Association of American Physicians & Surgeons (“AAPS”).

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