Navigating the Ryan Haight Act: What Hospice Leaders Need to Know

In 2001, Ryan Haight, a young man, tragically died from an overdose of prescription medication he obtained online.  His death spurred the 2008 enactment of the Ryan Haight Online Pharmacy Consumer Protection Act.  At its core, the act was designed to curb the illegal sale of controlled substances online, requiring practitioners to conduct at least one in-person evaluation before prescribing controlled medications via telehealth.

While well-intentioned, the legislation has had far-reaching consequences across healthcare, particularly in telemedicine and hospice care.  The COVID-19 pandemic prompted temporary waivers to the act, allowing controlled substances to be prescribed remotely.  These flexibilities, now extended until December 31, 2025, have highlighted both the opportunities and challenges of telehealth in hospice and palliative care.

Impact on Hospice and Telehealth

Hospice leaders know that timely access to medications is critical for patients’ comfort and quality of life.  However, the Ryan Haight Act and the DEA’s proposed new rules could impose additional hurdles. The act originally required in-person evaluations, a standard difficult to implement for homebound hospice patients.  During the pandemic, waivers allowed telehealth prescriptions for Schedule II–V medications, including opioids and other necessary medications for symptom management.

The DEA’s proposed “Advanced Telemedicine Prescribing Registration” (ATP Registration) would formalize a special registration process for prescribing controlled substances via telemedicine.  Hospice and palliative care physicians would need to navigate new registration, documentation, and monitoring requirements.  While intended to balance access with safety, these rules could increase administrative burdens, delay care, and create operational challenges for hospice programs.

Key Considerations for Hospice Leaders

1. Stay Informed on Regulatory Changes:  With temporary flexibilities expiring in December 2025 and new DEA proposals under review, it’s essential to monitor evolving requirements.  Hospice leaders should track rulemaking timelines and comment periods to influence policies impacting patient access.
2. Invest in Compliance and Technology: Telehealth for controlled substances requires robust systems for secure communication, identity verification, and recordkeeping.  Leaders should ensure staff are trained on compliance protocols while integrating interoperable technologies to streamline care and reduce operational risks.
3. Advocate for Hospice Needs:  Industry collaboration is critical.  Commenting on proposed rules and working with professional associations can help ensure hospice patients maintain timely access to essential medications without unnecessary administrative burdens.

Looking Ahead

The Ryan Haight Act reminds us that regulations designed to protect patients can have unintended consequences for healthcare delivery.  For hospice, the challenge is clear: balance regulatory compliance with patient-centered care.  By staying informed, investing in technology, and advocating for hospice-specific considerations, leaders can navigate this complex landscape and ensure patients receive the medications they need, when they need them.

Ultimately, the act and its evolving telehealth implications underscores the importance of proactive leadership in hospice, combining operational foresight, regulatory savvy, and compassion to meet the needs of our most vulnerable patients.

REFERENCE: PUBL425.PS; HHS-DEA.pdf