On Nov. 13, WHA submitted a comment letter to the Department of Health Services’ (DHS) Division of Care and Treatment Services on proposed rulemaking revisions to DHS 75
relating to community substance abuse service standards.
The officially proposed revisions are not final rules and still need to receive final review and approval by the DHS secretary, governor and legislative committees.
“The full administrative costs of the proposed rule are difficult to fully and precisely quantify, but together with professional requirements regulated by the Department of Safety and Professional Services, federal Substance Abuse and Mental Health Services Administration rules and requirements, payer requirements, liability risk mitigation and other overlapping state and federal regulatory requirements and processes that also assure minimum levels of quality and safety, the requirements in proposed DHS 75 add up to not insignificant administrative and opportunity costs for health care providers,” wrote WHA in its comment letter
on the proposed rule.
“We believe that the rule on the whole still needs additional work to reduce the regulatory burden and compliance costs of DHS 75 in order to achieve the goals to expand access to substance abuse treatment throughout Wisconsin,” WHA’s comment letter continued. “We appreciate that the draft proposed rule does eliminate some outdated and unnecessarily prescriptive provisions that should reduce unnecessary regulatory cost. However, in many cases throughout the recreated rule, unnecessary detail and prescription remains, and in cases such as the new regulation of office-based opioid treatment, will create new compliance requirements and costs.”
The comment letter highlighted the following points:
The impact of over-regulation on access to substance use disorder services –
The letter highlights multiple comments and discussions that have occurred in task forces, listening sessions, and committees—including the 2017 executive order identified as the impetus for the rulemaking—emphasizing the need to simplify and streamline substance use disorder regulation to ease access to substance use disorder services.
Comparative complexity compared to the current rule and other states’ requirement –
To help objectively measure the regulatory complexity and prescriptiveness of the proposed rule, the letter analyzed the word count, paragraph count, and definition count of the proposed rule, the current rule and comparative federal and other states’ rules. That analysis found that by each measure, the proposed rule significantly exceeds the current rule and the comparative rules.
Access impacts caused by the unnecessary—and last minute—creation of significant new regulatory burden on office-based buprenorphine providers –
The letter requests that DHS remove a new office-based opioid treatment section that would overlay on top of federal Drug Enforcement Administration (DEA) regulations significant new state regulatory requirements on office-based providers authorized to prescribe or administer buprenorphine. Multiple Wisconsin task forces have identified the need to encourage more buprenorphine prescribers in office-based settings, and the existing federal DEA requirements on buprenorphine prescribers already deter physicians from becoming buprenorphine prescribers. The letter further raises concerns that this significant additional regulation was never discussed by the DHS 75 Advisory Work Group.
A list of specific regulatory issues with current DHS 75 previously identified by WHA members –
The letter reiterated several specific issues previously identified by WHA members to reform current DHS 75, some of which are addressed in the proposed rule. The letter asked that each of the specific issues be addressed in the final rule.
DHS has reached out to WHA to continue discussing the proposed DHS 75 rule. WHA will continue working with DHS on improving the proposed rule prior to its final publication.
If you have questions or would like more information about the DHS 75 rulemaking, contact WHA General Counsel Matthew Stanford