Some Clinicians Get Mixed Messages on EPCS Mandates

Partly due to the pandemic response, some clinicians across the country are getting mixed messages from federal and state regulators on when they need to start electronically prescribing controlled substances. Meanwhile, all California providers must begin e-prescribing on Jan. 1, 2022.

States including California, Indiana, Maryland, Michigan, Nebraska, New Hampshire, Utah, and Washington have electronic prescribing for controlled substances (EPCS) legislation taking effect on Jan. 1, 2022.

Grant Achenbach and Brandon Shirley, attorneys for the firm Krieg DeVault LLP, recently wrote an article on the website Lexology about the challenges facing providers in Indiana.  They noted that Congress passed the SUPPORT Act in 2018 requiring prescribers to issue electronic prescriptions on Jan. 1, 2021, for Medicare Part D controlled substances. Indiana followed up by enacting a similar requirement. But after the pandemic struck, both mandates were delayed. The authors also noted that the Indiana law provides various exceptions to the state mandate that are not reflected in the federal mandate.

To provide pandemic relief, the Centers for Medicare and Medicaid Services (CMS) delayed compliance with the federal mandate until Jan. 1, 2023, and has announced a soft enforcement of noncompliance with the federal mandate until Dec. 31, 2023. However, as the Kreig DeVault authors note, the Indiana mandate becomes effective Jan. 1, 2022, and Indiana providers should not rely on federal delays to avoid compliance with the state mandate.

In Michigan, the Department of Licensing and Regulatory Affairs (LARA) sent a formal statement to prescribers and stakeholders confirming that the Bureau of Professional Licensing’s (BPL) enforcement of the electronic prescribing standard will coincide with the CMS’s enforcement schedule for Part D prescription drug programs. Therefore, Michigan prescribers have until at least Jan. 1, 2023, before they will be required to electronically transmit all prescriptions for controlled and non-controlled substances. A story on the website of the Michigan State Medical Society said the delay is due to CMS’ decision to postpone enforcement of Medicare’s e-prescribing mandate.

Beginning on Jan. 1, 2022, almost all prescriptions written in California must be transmitted electronically, according to the California Medical Association (CMA) — not just for controlled substances.  The electronic prescribing mandate was contained in a law passed by the California State Legislature in 2018. The bill (AB 2789) had a three-year delayed implementation to allow physicians and other prescribers the opportunity to select and implement an electronic prescribing platform. But the delay ends this week. 

The CMA noted that the federal delay of the EPCS mandate does not have any direct effect on the state requirement. “Much of the language of the requirement was copied straight from the federal regulations. Unlike the Medicare requirement, however, the state mandate applies to almost all prescriptions, not just those for controlled substances. In that respect, the state mandate is much broader than the Medicare one and will affect many more physicians.”