Mount Laurel, New Jersey -Array Behavioral Care is proud to be Certified™ by Great Place To Work® for the second year in a row. The prestigious award is based entirely on what current employees say about their experience working at Array. This year, 89% of employees said it’s a great place To Work – 32 points higher than the average mid-sized U.S. company. 

Great Place To Work® is the global authority on workplace culture, employee experience, and the leadership behaviors proven to deliver market-leading revenue, employee retention and increased innovation. 

"Great Place To Work Certification is a highly coveted achievement that requires consistent and intentional dedication to the overall employee experience," says Sarah Lewis-Kulin, the Vice President of Global Recognition at Great Place To Work. She emphasizes that Certification is the sole official recognition earned by the real-time feedback of employees regarding their company culture. “By successfully earning this recognition, it is evident that Array stands out as one of the top companies to work for, providing a great workplace environment for its employees." 

“I couldn’t be prouder of our organization and this recognition, based on the feedback of our amazing team members,” shares Shannon Werb, Chief Executive Officer at Array Behavioral Care.  “The need for our services is ever-increasing, countless patients rely on us to provide timely and effective behavioral care in a setting of their choice. Our mission of increasing access to care starts with our great clinicians, who are supported by our administrative team members, enabling them to practice at the top of their license delivering excellent care to our patients. "    

This year, Array has received multiple awards, including “Top Places to Work” by Ragan Communications, a Silver Bell Seal for Workplace Mental Health by Mental Health America, and a Fortune Best Workplaces in Healthcare. 

As a mental health organization, Array prioritizes a healthy workplace culture, providing resources through our Employee Assistance Program, mental health self-care, volunteer activities, professional development, a dynamic corporate wellness program with Peloton®, and a robust rewards and recognition program with Nectar. Through various employee-led Affinity groups, we celebrate our unique and dynamic culturally diverse team, highlighting and planning activities around various nationally recognized campaigns such as Minority Mental Health Month, Pride Month and Hispanic Heritage month, to name a few.  

WE’RE HIRING! 

Looking to grow your career at a company that puts its people first? Visit our careers page at: /about/careers 

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About Array Behavioral Care 

Array Behavioral Care is the nation's leading clinician-centric virtual psychiatry and therapy practice with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care, from hospital to home, through its three flexible delivery models. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community health care organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities, and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com. 

About Great Place to Work Certification™ 

Great Place To Work® Certification is the most definitive “employer-of-choice” recognition that companies aspire to achieve. It is the only recognition based entirely on what employees report about their workplace experience – specifically, how consistently they experience a high-trust workplace. Great Place to Work Certification is recognized worldwide by employees and employers alike and is the global benchmark for identifying and recognizing outstanding employee experience. Every year, more than 10,000 companies across 60 countries apply to get Great Place To Work-Certified.  

About Great Place To Work® 

As the global authority on workplace culture, Great Place To Work® brings 30 years of groundbreaking research and data to help every place become a great place to work for all. Their proprietary platform and For All™ Model helps companies evaluate the experience of every employee, with exemplary workplaces becoming Great Place To Work Certified™ or receiving recognition on a coveted Best Workplaces™ List.  

Learn more at greatplacetowork.com and follow Great Place To Work on LinkedIn, Twitter, Facebook and Instagram. 

September 11, 2023

The Honorable Anne Milgram
Administrator
United States Drug Enforcement Administration
800 K Street NW Suite 500
Washington, D.C. 20001

Dear Administrator Milgram:

Thank you for your willingness to further listen and meet with stakeholders, specifically medical practitioners, on the proposed rules for prescribing controlled substances via telehealth. We, the undersigned, collectively employ approximately 1,600 mental health professionals and treat over one million patients annually. As the largest organizations working in telepsychiatry, we have extensive expertise in the practice of medicine through telehealth, and are committed to responsibly continuing and expanding access to mental health services for patients beyond the traditional in-person office-based model.

We understand the DEA’s difficult job in balancing access to care with diversion prevention. To that end, we will be using our time at the listening session to propose a Special Registration process that will accomplish our collective goal of legitimate and safe prescribing without compromising access to needed care for millions of Americans. The following pages outline our recommendations for this Special Registration process.

Thank you for your consideration of what we believe to be a path forward that will allow the DEA to maintain important controls on prescribing, while ensuring practitioners can continue to offer crucial patient care.

Sincerely,

Talkiatry
Quartet Health / innovaTel Telepsychiatry
Array Behavioral Care
Iris Telehealth

DEA Proposal Overview

Overview
Under the proposed rules for telemedicine issued on March 1, 2023[1], many Americans who rely on telemedicine services will lose access to mental health, substance use disorder, and other healthcare services. To prevent this, we recommend the DEA enact a Special Registration for telemedicine to allow the safe prescribing of controlled substances through telemedicine while preventing diversion. This Special Registration will be in addition to the proposed rule that allows for prescribing via telemedicine after a qualified referral from an in-person provider. Under our proposal, the DEA will issue two registration licenses: 1) the commonly known DEA Registration, and 2) a new Special Registration.

The 1) DEA Registration will continue to exist for providers prescribing Schedule II-V medications in the circumstances allowed under the current[2] and proposed1 rule, including the following circumstances:

  1. Treat patients in-person,
  2. Treat patients via telemedicine where at least one in-person evaluation occurred, or
  3. Treat patients via telemedicine that have been referred from a DEA-registered provider that had at least one in-person medical evaluation (see footnote 2 for other limited circumstances allowed)

The 2) Special Registration will apply to providers prescribing Schedule IIN non-narcotic, III, IV and V medications ONLY when a provider has not treated a patient in-person nor has a referring provider treated a patient in-person.

DEA Registration

Special Registration

  • Allows qualified providers to prescribe Schedule II (any duration) and Schedule III-V (>30 days) medications via telehealth after 1) an in-person visit, or 2) qualified referral from in-person provider (other limited circumstances allowed2)
  • Primarily impacts incidental telemedicine prescribers (i.e., providers who see patients in both in-person and virtually)

+

  • Allows qualified providers to prescribe Schedule IIN non-narcotic, III, IV, and V medications via telemedicine without an in-person visit or referral
  • Primarily impacts large provider groups that see patients predominantly or exclusively via telemedicine without an in-person evaluation.
  • Exemptions from certain requirements for a) providers at not-for-profit organizations or hospitals (for-profit and not-for-profit) and b) buprenorphine prescriptions

Focus of this document

Special Registration Details

  • Guardrails govern and limit the authority granted by the Special Registration (see next page).
  • So long as a provider holds a DEA registration, only one Special Registration is required to prescribe controlled substances in all 50 states, D.C. and its territories. Providers would not need a separate registration for each state where they practice.
  • Providers would not be required to maintain a physical location or to physically store records in each state where they practice. Providers can store records electronically, in common spreadsheet formats or certified electronic medical records (EMR).
  • Providers can prescribe controlled substances under the authority of the DEA Registration or the Special Registration, based on the setting of care in which they treat each patient.

Proposed Guardrails for the Special Registration
The following guardrails would minimize diversion without materially restricting access. To avoid creating undue administrative burden, we have broken these out into two categories:

  1. Guardrails that apply to all providers prescribing Schedule II-V, with no exemptions
  2. Guardrails that apply to all providers prescribing Schedule II-V, with exemptions for:
    1. Providers practicing at not-for-profit organizations (as defined in the IRS Code exempt organizations under 501(c)(3)) or hospitals (both for- and not-for-profit)
    2. Prescriptions of buprenorphine
Category Guardrail Rationale
1. Guardrails that apply to all providers prescribing Schedule II-V controlled substances, with no exemptions
Visit Frequency
  • Require providers to evaluate the patient at least once every 90 days to continue to prescribe controlled substances
  • Regular cadence of care is necessary to appropriately titrate medication
Visit Type
  • Require providers to have the capability and to offer synchronous audio/video visits and communicate with patients via a HIPAA compliant platform
  • Critical to maintain high quality care
Pharmacy Affiliations
  • For controlled substance prescriptions, prohibit telemedicine practitioners from requiring, recommending, referring, or suggesting a patient utilize a specific registered pharmacy, unless the patient initiates the request for a suggestion or recommendation of a pharmacy
  • Critical to maintain quality care and avoid misaligned incentives
Authority to prescribe
  • Limit the authority for qualified providers to the prescription of medications for standard of care
  • The authority to store and dispense these medications on site would not be granted via Special Registration
  • Physical locations for storing and dispensing medications are out of scope of the Special Registration
Ketamine
  • Exclude ketamine from the list of medications that can be prescribed under the Special Registration (can still be prescribed under the DEA Registration)
  • If the FDA approves labeling for a ketamine drug for patients to self-administer at their domicile or finds it to be safe for a patient to administer without medical supervision, the DEA will review this prohibition and seek amendment to this regulation
  • Ketamine is approved for treatment resistant depression
  • In-person observation is the standard of care after prescription to allow provider to intervene if necessary
Schedule II
  • Limit Schedule II to Schedule IIN non-narcotic medications
  • Limit to treatment of mental health conditions
  • Require prescribers to satisfy one of the following:
    • Physician
    • Certified advanced practice Nurse Practitioner with a Board Certification in Psychiatric-Mental Health from ANCC
    • Physician Assistant with certificate of added qualification of Psychiatry from NCCPA
    • Completed 8 hours of approved State licensing medical board or its equivalent continuing medical education credits related to ADHD
  • Schedule IIN non-narcotic drugs are critical to treating legitimate mental health needs, while broader Schedule II have a history of abuse
Category Guardrail Rationale
2. Guardrails that apply to all providers prescribing Schedule II-V controlled substances, with exemptions for a) providers practicing at not-for-profit organizations or hospitals (both for- and not-for-profit) and b) prescriptions of buprenorphine
Limits on Rx volume
  • Limit controlled substance prescriptions to 500 per provider per month (recommended)
  • Limit number of patients on a controlled substance to 275 per provider (alternate limit)
  • For either limit recommendation, in specific circumstances where a practitioner exceeds the limit(s), consideration will be given to the reason documented in the patient’s medical record
  • While roughly equivalent, we recommend a limit on controlled substance prescriptions rather than patients:
    • Prescription volume is easier to track
    • Patients may be prescribed more than one controlled substance
    • Provider coverage (for doctors on vacation or leave) would complicate per provider patient count
  • Limits potential for abuse, consistent with pre-existing DEA regulations
Data reporting
  • For each provider, report the following non-PHI data to the DEA on a quarterly basis:
    • Prescriber DEA registration number
    • Healthcare Entity the prescription was affiliated with
    • Name of drug(s) prescribed
    • Number of prescriptions for each drug
    • Date of prescription(s)
  • Providers may delegate reporting authority to others and the delegate will be provided to the DEA
    • For example, if a medical practice employs multiple medical practitioners that are required to report, the practitioners may delegate to the medical practice entity to report on their behalf
    • Alternatively, medical practitioners may delegate the reporting to an administrative person or may contract with a third party for reporting
  • This data can be stored and reported in common spreadsheet formats, in the format of a Certified Electronic Health Record (CEHR), or in other formats approved by the DEA
  • Reports can be submitted to the DEA electronically via online reporting, electronic file upload, or other means as approved by the DEA
  • Allows DEA to access previously hard to get data
  • Creates accountability to minimize risk of diversion
  • Protects patients’ privacy by removing PHI
  • DEA to propose the format and mechanism for the sharing of these reports within 6 months of the Special Registration process being created, and to allow sufficient time for public comment
  • DEA may also consider pharmacy prescription data as not all prescriptions written are filled by patients

 

 


[1] 88 FR 12875; 88 FR 12890; Telemedicine Encounter Notice of Proposed Rulemaking Rules for Controlled Substances (March 1, 2023)

[2] Exceptions to the Ryan Haight Act are: 1) treatment in a hospital or clinic; 2) treatment in the physical presence of a DEA-registered practitioner; 3) treatment by Indian Health Service or Tribal practitioners; 4) treatment during a public health emergency as declared by the Secretary of Health and Human Services; 5) treatment by a practitioner who has obtained a “special registration”; 6) treatment by Department of Veterans Affairs practitioners during a medical emergency; and 7) other circumstances specified by regulation. See 21 C.F.R. § 1300.04(i)(1)-(7).

 

New Talent will Accelerate the Nation’s Leading Virtual Psychiatry and Therapy Provider in Growing and Diversifying its Services, Technology, and Operations Across Care Continuum

MOUNT LAUREL, NJ – Sept. 6, 2023 — Array Behavioral Care, the nation’s leading clinician-centric virtual psychiatry and therapy practice, announced three executive leadership hires: Shannon Werb, Chief Executive Officer; Sara Gotheridge, MD, Chief Medical Officer; and Ben Schlang, Chief Financial Officer. These new leaders will support the execution of broader company-wide initiatives and investments across technology, operations, and teams to expand the breadth and depth of Array’s telebehavioral services across the care continuum.

Demand for mental health care remains high in acute care and community outpatient settings, where capacity is significantly constrained. Less than one-third of all mental health needs are being met nationwide, according to research conducted by the U.S. Department of Health & Human Services. Virtual psychiatry and therapy enable more patients to receive care directly from clinicians across all settings. Array pioneered this industry, with Array Co-founder Dr. Jim Varrell performing one of the industry’s first telepsychiatry encounters in 1999. Today more than 90 million Americans in all 50 states can access Array’s timely, quality behavioral health care services in hospitals, community clinics, primary care offices, and at home. Array has delivered nearly four million virtual encounters to date.

“At Array, we speak about our ability to diversify and scale effectively, not only as strategic and operational business imperatives, but importantly, as a fundamental responsibility in fulfilling commitments to our customers and the patients we serve—we’re mission-bound to meet our nation’s ever-increasing demand for behavioral care,” said Glenn Cole, Array’s Board Chairman. “The Board is grateful for all that Array’s executive team has done in establishing Array as the industry leader, and is thrilled that founders Jim Varrell and Geoffrey Boyce will continue to work alongside Shannon, Sara, Ben and other Array leaders to develop and execute a shared vision and strategy to more effectively address mental health needs across the country.”

Werb, Gotheridge, and Schlang bring substantial healthcare experience, and proven success in their respective domains, including business strategy and operations, clinical, and financial. Werb has more than 25 years of experience as a healthcare executive and driver of value creation in the provider and related healthcare technology industries. Previously, he served as COO at DispatchHealth, where he played a key role in diversifying the company’s capabilities to multiple service lines, while scaling delivery across more than 40 states. Prior to that, Werb was president and COO of vRad, a global telemedicine company and the nation’s largest radiology practice.

Array is poised to accelerate its pace of scale in new and existing markets through enhanced service offerings and operations, innovative technology, and expansion of the practice team. Array’s unique service delivery models will deliver timely and high-quality care across the continuum, regardless of setting, and continued investment in Array’s leadership will drive more comprehensive solutions to Array’s hospital and payor partners. Amid growing national concern for mental health, timely intervention is valuable and appropriate follow-up care is critical. Array is investing in both.

“We’re at a critical inflection point for telehealth—we’ve experienced wide-scale adoption and efficacy, and we must ensure we maintain that commitment in order to best meet the nation’s mental health care needs,” said Werb. “It’s an honor to lead an industry innovator and build on our legacy as a great place for clinicians to practice care and for patients to receive care.”

Along with Werb, Array welcomes Gotheridge to oversee Array’s clinical team and quality program, and Schlang to manage the company’s financial operations. In addition to growing multiple practices throughout her 25-year career, Gotheridge is an experienced CMO within community mental health and has unique expertise in integrated care. She will oversee all clinical services, maintain active clinical practice, and partner closely with Array’s operations team to ensure that the highest quality of care is delivered to patients in a scalable and sustainable way. Schlang brings more than a decade of private equity experience in healthcare investment and finance and has been actively involved with Array for nearly six years as a member of one of Array’s institutional investors, Harbour Point Capital.

“We built the foundations for Array more than 20 years ago because we knew that virtual care offered patients in critical need access to the right care at the right time,” said Geoffrey Boyce, Array’s Founder. “Now more than ever, we see the importance of our mission and recognize the need to grow our organization to meet patients’ increasing mental health care needs. With these new leaders, Array is poised to maximize the expertise of our exceptional clinicians and enhance our offerings and delivery at an accelerated pace.”

In January 2023, Array completed a Series C capital raise led by CVS Health to further scale Array’s modern behavioral care services across the continuum. Array’s clinical, operational, administrative, and technical specialists enable its to clinicians operate at the top of their licenses, integrate with care teams, and similarly practice as they would if they were physically present with the patient. Array was named a Fortune 2023 Best Workplaces in Healthcare, following last year’s receipt of Great Place to Work® certification.

About Array Behavioral Care

Array Behavioral Care is the nation's leading clinician-centric virtual psychiatry and therapy practice with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care, from hospital to home, through its three flexible delivery models. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community health care organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities, and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.

MOUNT LAUREL, NJ – Sept. 6, 2023 — Great Place To Work® and Fortune magazine have selected Array Behavioral Care for the 2023 Fortune Best Workplaces in Health Care™ List. This is Array’s first time being named to this prestigious list. Earning a spot means that Array is one of the best companies to work for in the country.  

The Best Workplaces in Health Care award is based on analysis of survey responses from over 208,000 employees from Great Place To Work Certified companies in the health care industry.  

“Array is a clinician-centric organization, and people are at the heart of everything we do in succeeding in our mission of transforming access to behavioral care services” says Kelly Lewis, Chief People Officer. “It’s important for us as an organization to ensure that employees are first caring for themselves in order to have the capacity to care for others, so we have built a healthy work culture that is weaved throughout our mission and values, our mental health and physical wellness programs, our training and development structure, and so forth. It is such an honor to be named a Best Workplace in Health Care among our peers.” 

The Best Workplaces in Health Care list is highly competitive. Great Place To Work, the global authority on workplace culture, determines its lists using its proprietary For All™ Methodology to evaluate and certify thousands of organizations in America’s largest ongoing annual workforce study, based on over 1.3 million survey responses and data from companies representing more than 7.5 million employees this year alone.  

Survey responses reflect a comprehensive picture of the workplace experience. Honorees were selected based on their ability to offer positive outcomes for employees regardless of job role, race, gender, sexual orientation, work status, or other demographic identifier.  

“Congratulations to the Best Workplaces in Health Care,” says Michael C. Bush, CEO of Great Place To Work. “These companies know that it isn’t the industry — but the company — that determines the employee experience. By putting people first, they are reaping the rewards: lower labor costs, higher standards of care, and happier employees.” 

Fortune congratulates the Best Workplaces in Health Care,” says Fortune Editor-in-Chief Alyson Shontell. “Creating a vibrant workplace culture that draws the best talent in health care is vital for the success of the leaders in this highly competitive industry. It is also what’s needed to ignite innovation and deliver best-in-class performance.” 

This year, Array has been awarded a Great Place to Work®, A Top Places to Work® by Ragan Communications, named among Best Virtual Therapy Companies by Verywell mind, and received Mental Health America’s prestigious Silver Bell Seal for Workplace Mental Health. Two of its leaders, Chief People Officer Kelly Lewis and Medical Director of Engagement, Dr. Jamie Evans, were both named Top Women in Wellness and HR by Ragan. 

About Array 

Array Behavioral Care is the nation's leading clinician-centric virtual psychiatry and therapy practice with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care, from hospital to home, through its three flexible delivery models. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community health care organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities, and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com. 

About the Fortune Best Workplaces in Health Care List 

Great Place To Work selected the 2023 Fortune Best Workplaces in Health Care by gathering and analyzing confidential survey responses from more than 208,000 employees at Great Place To Work Certified organizations in the health care industry. Company rankings are derived from 60 employee experience questions within the Great Place To Work Trust Index™ Survey. Great Place To Work determines its lists using its proprietary For All™ Methodology to evaluate and certify thousands of organizations in America’s largest ongoing annual workforce study. In the last year, 1.3 million survey responses were received and data from companies representing more than 7.5 million employees, this year alone. Read the full methodology. 

To get on this list next year, start here.  

About Great Place To Work
As the global authority on workplace culture, Great Place To Work brings 30 years of groundbreaking research and data to help every place become a great place to work for all. Its proprietary platform and For All™ Model helps companies evaluate the experience of every employee, with exemplary workplaces becoming Great Place To Work Certified or receiving recognition on a coveted Best Workplaces™ List.  

Follow Great Place To Work on LinkedIn, Twitter, and Instagram or visit greatplacetowork.com and sign up for the newsletter to learn more. 

About Fortune
The Fortune mission is to change the world by making business better. We achieve that by providing trusted information, telling great stories, and building world-class communities. We measure performance by rigorous benchmarks. And we hold companies accountable. Our goal is to make Fortune a force for good through its second century and beyond. For more information, visit www.fortune.com. 

MOUNT LAUREL, NJ, May. 22, 2023 — Array Behavioral Care is proud to be Certified™ for Mental Health’s America’s (MHA) Silver Bell Seal for Workplace Mental Health.  

This national recognition is awarded to employers who are truly committed to creating mentally healthy workplaces and take a holistic approach to evaluating employer’s best practices in a variety of different competencies. Only 13% of all workplaces who applied for this certification qualified for this honor.  

As a Bell Seal recipient, Array joins a community of leaders who transform the workplace environment into a more supportive and healthier culture where employees can thrive.  

"At Array, we live by our core values of being an inclusive, supportive, collaborative, wise and solutions-oriented organization. Receiving this recognition is truly an honor, and one we don’t take for granted” said Kelly Lewis, Chief People Officer of Array Behavioral Care. “We recognize that an investment in employee mental health is an investment in the organization’s financial, social, and emotional health, and that’s truly at the heart of everything we do.” 

Array continuously works to enhance its culture and offer multi-faceted wellness programs for its administrative and clinical team members. Over the past year, we’ve offered a more robust Employee Assistance Program, increased efforts to support professional development, launched our corporate wellness program with Peloton® and have continued to celebrate our dynamic and culturally diverse teams through various Affinity group initiatives. There’s a little something for everyone and we want to make sure everyone feels supported, no matter what their role here within our organization. 

We're Hiring!

Looking to grow your career at a company that puts its people first? Visit our professional careers page on our website here.  

About Array Behavioral Care 

Array Behavioral Care is the nation's leading clinician-centric virtual psychiatry and therapy practice with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care, from hospital to home, through its three flexible delivery models. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community health care organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities, and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com. 

MOUNT LAUREL, N.J. – May X, 2023 — Array Behavioral Care, the nation’s leading virtual psychiatry and therapy practice, was recently awarded a ‘Top Places to Work’ by Ragan and received honorable mention for several other awards, including ‘Best Remote Work Experience,’ ‘Amazing Workplace Culture’ and ‘Employee Experience and Engagement.’  

As a predominately remote culture, even prior to the pandemic, Array has always prioritized the mental health and wellbeing of its valued employed, with programs designed to support four key pillars – Transparent Communication, Multi-Faceted Wellness, Training & Development and Culture & Connectedness.   

From quarterly all hands meetings, biannual clinician town halls, active Microsoft Teams channels and monthly newsletters, we pride ourselves on keeping our employees well-informed about all that’s happening in and around our organization and the behavioral health industry. Between a dynamic corporate wellness program with Peloton®, weekly meditation sessions and virtual group classes, free annual CALM app subscriptions and a robust EAP program, we strive to meet employees where they are to support the whole person.  Our fully integrated learning management system, regular live training workshops, dedicated continuing education committee, clinician-led community events with CME opportunities, and individual development plans for employees places a high value on professional development.  Last but certainly not least, a dedicated Engagement team and a Diversity, Equity & Inclusion committee oversees culture and connectedness. Through various employee-led affinity groups and virtual activities, nationally recognized campaigns such as black history month, Hispanic heritage month, mental health month, and Pride month, just to name a few, we take celebrating culture and diversity to a whole new level. Our rewards and recognition program through Nectar allows employees to recognize one another for their contributions and how they are exemplifying our core values here at Array. 

Three designated surveys held at key intervals throughout the year allow Array to keep the pulse on how employees are feeling, ensure they are aligned with department and individual goals, and provide opportunities to share their candid feedback.  We in turn review, share, and address areas for improvement that ultimately create positive impacts across the organization. Our surveys focus on supervisor and leadership effectiveness, corporate culture, work environment, role satisfaction, pay and benefits, employee wellness and burnout, and diversity, equity, and inclusion.   

Array’s Talent Engagement Manager, Desiré Stasen, attended a luncheon at City Winery in Chicago to accept the award on Array’s behalf. When asked what makes Array stand out from other organizations, she shared how Array’s wellness programs, affinity groups and cultural initiatives are designed to meet employees where they are, encouraging them to bring their unique selves to work every single day. “Mental health is at the heart and center of everything we do at Array” Stasen said. “We all know you can’t pour from an empty cup, so we provide programming and resources to support the mental health of our valued employees who, in turn, support the mental health needs of hundreds of thousands of others.” 

Geoffrey Boyce, Array’s CEO agrees. “A company is only as good as its people. As a mission-driven provider of behavioral care, our people are the very heart of our organization and are our greatest asset.  Being recognized by Ragan as a top place to work with consideration for our amazing culture and employee experiences is truly something to be celebrated.” 

Ragan Communications supports internal and external communicators, HR professionals and business executives across the country through conferences, webinars, training, and daily news publications, with a well-appointed Communications Leadership Council at the helm for public relations, marketing, and social media professionals. 

To learn more about Array Behavioral Care, please visit www.arraybc.com.

###

About Array Behavioral Care

Array Behavioral Care is the nation's leading clinician-centric virtual psychiatry and therapy practice with a mission to transform access to quality, timely behavioral health care. Array offers telepsychiatry solutions and services across the continuum of care, from hospital to home, through its three flexible delivery models. For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community health care organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities, and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com. 

Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation (Docket No. DEA-407)

We at Array Behavioral Care applaud the Drug Enforcement Agency (DEA) for its work in recognizing the importance of telehealth and the value it has been able to provide patients before COVID-19, during the pandemic, and for years to come. As a telemental health organization that provides telepsychiatry services across the care continuum from hospitals to homes, we have seen the positive impacts that the relaxed pandemic telehealth regulations have had for patients across the country.

As you and our colleagues at DEA are aware from our prior interactions on this topic, members of our practice have been conducting telepsychiatry since 1999, and our 50-state experience before and during the pandemic, has proven to us that safe and effective prescribing of certain controlled substances via telemedicine is both possible and essential.

Our perspective is that of a virtual psychiatry and therapy practice, and our comments reflect that emphasis.

While we appreciate the DEA’s work on rules to control against diversion and to protect public health, we are concerned with the timeline to finalize and implement the proposed rules. To ensure practitioners and organizations fully understand the new process and can make any necessary operational changes, we urge the DEA to extend the PHE flexibilities at least until the rule is finalized and implementable.

With that being said, here is a summary of our recommended changes:

  1. Extend the window between a new initial telemedicine prescription and an in-person examination from 30 days to 90 days
  2. Remove the requirement that telemedicine prescribers be DEA registered in the state where they are physically located (unless prescribing for patients in that state)
  3. Enable only schedule IIN stimulants (i.e., Adderall, Dexedrine, Desoxyn, Ritalin) to be prescribed after an initial telemedicine encounter in the same way as currently proposed for schedules III-V
  4. Exclude patients who have been receiving a schedule III-V controlled substance and children and adolescents who have been receiving a schedule II stimulant during the PHE from the requirement to obtain an in-person examination if the prescription was initiated prior to February 7, 2023
  5. Clarify that the “Telemedicine referral” documentation needs to reflect the name, NPI, and findings of the in- person examination, but not a specific name or NPI of the telemedicine practitioner receiving the referral
  6. Create viable mechanisms for telemedicine prescribers who do not see patients in-person to obtain DEA registration by unlinking the address used on the application from the idea of that address being a practice location.
    a. Decoupling the act of writing a prescription from the act of storing, dispensing, administering, or maintaining a drug would be helpful in this regard
    b. It would also reduce diversion risk by limiting sites storing drugs and reduce the burden of DEA investigators with certain site inspections

 

1. 1306.31(4)(2)

While we appreciate that the DEA believes that prescribing schedule III-V controlled substances can occur after an initial evaluation and assessment via audio/video visual means, we do question why it is limited to 30 days. The challenge that may happen for patients and prescribers is that it may take more than 30 days, (e.g., for certain behavioral health conditions) to ensure that a medication is working and some adjustments in the dosage and medication may be needed. Under this rule, the limitation of prescribing to 30 days may put prescribers at risk from a standard of care and not provide proper treatment for the patient, in which they have a duty of care for those patients as they have established a proper physician-patient relationship (via telemedicine).

Furthermore, and possibly more importantly, not all patients may have an immediate local in-person provider or PCP to see within those 30 days. This can be due to a lack of schedule availability or unwillingness to take on new patients by that in-person provider. As a result, this “initial prescription” may not be helpful to the patient in the long-term if the treatment cannot continue due to this requirement. It also adds undue burden on already overstretched primary care providers.

Additionally, if a patient does not have an in-person provider, the proposed 30-day timeframe to comply with an in- person visit may inadvertently create situations for more waste and abuse. There is risk of increased unnecessary medical costs for these patients trying to comply with the new rules only to end up going back to the telehealth prescriber to continue a prescription already written based on the initial telehealth visit.

The example we present is a patient that seeks out a psychiatrist for mental health treatment via telehealth and receives a 30-day initial prescription for a schedule IV anti-anxiety medication after the evaluation and assessment. According to the proposed rule, to continue to prescribe, the patient must go back to their PCP solely to have an “in-person visit” to complete a telemedicine referral form. It can be assumed then that the PCP will submit a bill for those services to the patient or insurance payer, or possibly in some cases, may decline to do this because no immediate reason for the medical visit is necessary. As a result, this may cause financial waste and time taken away from the PCP to care for any patients that may have more immediate needs.

We recommend extending the time period for an initial schedule III-V prescription to 90 days.

2. 1306.31(a)(3)(i)

Per the Controlled Substances Act (CSA), practitioners prescribing controlled substances to patients via telemedicine must hold a DEA registration in the state where the patient is located. There has been no requirement that the practitioner must also hold a DEA registration in the state where they are physically located. However, under proposed 1306.31(a)(3)(i), practitioners would need to maintain a DEA registration both in the state where the patient is located and where the practitioner is located. This requirement would be burdensome and wasteful to telemedicine practitioners who do not practice or prescribe in the state where they reside.

We recommend removing the requirement that practitioners maintain a DEA in their home state, unless they are prescribing in that state, but maintaining the requirement that a DEA registration be required in the patient’s state. Maintaining a DEA registration in the state where the patient is located is a standard practice within the telemedicine industry. However, requiring practitioners who do not prescribe to any patients in their home state to maintain a DEA registration would be a significant shift from the previously maintained requirement.

3. 1306.31(4)(c)(1)

We acknowledge that schedule II substances may create a risk to public health and safety if not monitored and dispensed in a medically appropriate manner. But we do want to point out that there are several safeguards already in place within the other aspects of the proposed rule (e.g., qualified telemedicine referral) and through other mechanisms to monitor and enforce that prescribing is done in a safe manner.

First, we believe that the ones most affected by this strict in-person requirement will be those patient populations that include minors under the age of 18, and those in areas where there is a shortage of mental health providers who have the expertise and ability to treat these patients.

From a clinical perspective, patients who may require schedule IIN prescriptions to treat conditions such as ADHD can be safely treated via telehealth. It has been accepted within the medical community and through state medical practice acts or legislative statutes that an audio/visual synchronous visit can be just as effective and meets the standard of care as it would have been if performed in-person. This is because the symptoms of these conditions (e.g., ADHD) are neurological and cannot always be visibly seen through a physical examination. Furthermore, professional standards of care have already been established to ensure appropriate safeguards are in place. National organizations like the American Psychiatric Association (APA), American Academy of Child and Adolescent Psychiatry (AACAP), and the American Telemedicine Association (ATA) have published guidelines that detail the best practices a mental health provider should take to appropriately diagnose and prescribe via telemedicine (i.e., verify the identity of the patient, collect collateral, obtain parental consent for minors, etc.)

Additionally, other safeguards already in place that would allow for these telehealth visits to occur safely include: 1) all 50 states require providers as part of their licensure obligations to review PDMP databases for any potential overprescribing or diversion; 2) pharmacists also have the ability to provide oversight and discretion when these prescriptions are dispensed and picked up to ensure that the prescription was medically appropriate and also validate the individual picking up the prescription; and 3) healthcare providers are subject to civil and criminal sanctions and disciplinary actions from their state licensing boards, state regulatory and law enforcements agencies, and the DEA.

Therefore, while we would recommend and strongly encourage that prescribing of Schedule II controlled substances could occur via telehealth, if the DEA strongly believes that there should be additional guardrails in place, we recommend that schedule IIN substances (i.e., Adderall, Dexedrine, Desoxyn, Ritalin) should be exempted from this initial in-person requirement, and that they should be treated in the same way as Schedules III-V under these new regulations.

4. 1300.04(o)

Given the length of the public health emergency period, there are many patients who have been seen only via telehealth for almost 3 years due to the accommodations that the DEA has allowed. If there was any indication that overprescribing, drug diversion, or other misuse was occurring during this time, there would have been much more evidence and reports of potential overdoses, lack of medication adherence, and patient harm. There is lack of evidence that this has occurred in the medical community and industry.

Additionally, all 50 states have allowed through the state Medical Practice Acts or other legislative statutes, that a valid patient-physician relationship can be established via telehealth. To require that any established telemedicine relationships must now have at least one in-person visit by a provider is an unnecessary cost for the patient and/or the insurance companies, and does not justify such a requirement, especially for a patient who has been seen via telehealth over such an extended period.

We recommend the in-person exam requirement for provider-patient relationships that were established during the PHE be removed or have other guardrails in place. For example, if the initial visit has occurred within the last 90 days prior when these new rules become in effect, then an in-person visit may be warranted, but not one if the patient has been seen during the duration of the PHE.

5. 1300.04(k)

Within the definition of a “qualifying telemedicine referral,” it outlines that the “referral must note the name and National Provider Identifier (NPI) of the practitioner to whom the patient is being referred.”

Requiring the name of a specific practitioner and their individual NPI number on a referral is far too burdensome on both the referring provider and the patient. For referring providers, it would require them to have an identified telehealth provider that they can refer patients. Particularly for behavioral health providers, in many parts of the country, there are little to no local resources available and thus, referring providers are unlikely to know specifically which providers they can refer patients to and are far less likely to know if those practitioners are accepting new patients. In some cases, it is left to the patient to contact their insurance carrier or search on the internet for a specialty provider. Furthermore, it would require pre-referral preparedness such as identifying a provider they want to be referred to, obtain that provider’s NPI number, and confirm they have availability to be seen. This is completely impractical.

Instead, we strongly recommend removing the requirement that the referral must list a specific practitioner and instead allow the patient to be referred generally to a telemedicine practitioner.

6. Maintaining addresses in states where practitioners do not reside or have a physical office location

Although not specifically addressed in the proposed rule, we wanted to address one other consideration while you are evaluating the regulations around telehealth prescribing. In your rationale as to why practitioners do not need addresses in each state where they see patients via telemedicine for the purposes of storing medical records, you explain:

“If DEA instead were to require records to be maintained in the State(s) where telemedicine patients are located, practitioners could theoretically have to maintain telemedicine records in over 50 different locations (if they had a nationwide practice), including in states in which they may not retain a physical office location. This would be burdensome for both the practitioner and DEA investigators…This process would become impracticable if investigators had to obtain records from 50 different locations across the county, resulting in significant administrative waste (p.21).”

While we appreciate the recognition that the majority of practitioners now maintain electronic records, the burden still applies when practitioners need to apply for a DEA registration in a state where they are prescribing to patients via telemedicine, but they do not reside or have a physical office location in that state.

While we agree with the Controlled Substance Act (CSA) requirement of having a DEA registration in the state where the patient is located, for telemedicine practitioners, the DEA application for that registration is onerous given the physical address requirement. These telehealth practitioners do not have a physical office in the states where they are treating patients via telemedicine, yet the physical address requirement still stands. Just as you justify above regarding the storing of medical records, for practitioners who have a nationwide practice, they need to maintain a physical address in all 50 states to apply for a DEA registration. This is burdensome on both the practitioners and the DEA investigators, and we wanted to bring this issue to your attention and recommend revising the application regarding the physical address location for practitioners practicing via telemedicine.

Similarly, we would also like to request that the DEA reviews certain definition and categories to help clarify some terms that need to reflect current telehealth practices and standards.

“Administering”, “Dispensing”, “Maintaining” – These terms should not be interchangeable nor should be collectively grouped together as it relates to telehealth and reasons why an applicant may need a certain physical address vs practice address. In telehealth practice, it is practically non-existent that any clinicians will maintain any controlled substances or physical records at a physical location. Medical records are stored in an EMR, and controlled substance prescriptions are sent electronically to a pharmacy for the patient to pick up. Therefore, putting a physical address on a DEA application provides great confusion to the applicant since many of them are not in the same state where services are delivered, but still hold a valid state medical license where the patient will be sitting, and there is no limitation on those applications where that clinician needs to practice within the state.

To reduce diversion concerns, we propose that the DEA make a distinction between the authority to write a prescription and the authority to administer, dispense, or maintain controlled substances in how DEA registrations are issued. Practitioners who only conduct telemedicine do not need the authority to store, dispense, or maintain controlled substances, and we believe such a distinction could reduce diversion risk while also reducing DEA’s investigative burdens of certain site inspections.

On behalf of Array Behavioral Care, we appreciate the opportunity to provide comments and recommendations and we would be happy to offer any additional consultation.

James Varrell, MD, Executive Chief Medical Officer

Geoffrey Boyce, Chief Executive Officer

Leroy Arenivar, MD, Medical Director

Shane Rau, MD, Medical Director

Array is pleased to be featured among the best virtual therapy companies by Verywell Mind. Their independent research revealed very favorable results when testing our online therapy services. Our high-quality, easy-to-use service stood out among the trials with several other companies.

Array has recognized the need for improving access to quality behavioral health services since our first commitment via telepsychiatry in 1999, a moment that shaped our mission to transform how behavioral health care can reach more people in need.

As the nation’s leading virtual psychiatry and therapy practice, we employ hundreds of licensed behavioral health clinicians with specialties across the gamut and licensure in all 50 states, giving us the capacity and flexibility to scale and meet the growing demands of health care partners and patients nationwide. Read the review here.

CANTON, Ohio, Jan. 23, 2023 — US Acute Care Solutions (USACS), the largest physician-owned acute care practice in the nation, and Array Behavioral Care, the nation’s leading virtual psychiatry and therapy practice, today announced a strategic partnership to offer comprehensive acute medical and psychiatric care services to health systems.

With the newly formed Behavioral Emergency Stabilization and Treatment (BEST) model, USACS and Array will unite its clinical and technological expertise to combat the growing epidemic of acute mental illness that has impacted the nation for decades.

Patients with acute psychiatric issues have significantly higher average emergency department (ED) lengths of stay and are more likely to stay in the ED for longer than 12 hours than those with other medical conditions (Simko 2022)[1]. It is not uncommon for emergency departments around the nation to have psychiatric patients waiting days for specialist care and transfer to appropriate institutions. The burden on psychiatric patients and their families is paralleled by the challenges posed to the health system, especially during this time of staffing and resource shortages.

The downstream result of delays in acute psychiatric care has a domino effect on non-psychiatric patient care and throughput. Array’s sophisticated virtual psychiatric care platform and clinical expertise can improve the speed of evaluation, treatment initiation and patient throughput, which improves the quality of care for all patients in the acute care space. Additionally, by using virtual technology, Array and USACS will be able to facilitate quicker access to care and further address social determinants of health.

“By combining our strengths in emergency medicine, hospital medicine and critical care with Array’s expertise in behavioral care, we can meet the physical and mental health needs of our patients and support our health system partners with a comprehensive suite of acute care services,” said Chris Hummer, Chief Executive Officer of USACS.

“Our mission at Array is to help address the nation’s mental health needs by using technology to bring licensed behavioral health clinicians to patients everywhere. Together with USACS, we can help provide holistic care to more patients in acute care settings and enable the clinicians at USACS to work at the top of their license,” said Geoffrey Boyce, Chief Executive Officer of Array.

“Health systems see the effects of undertreated mental illness in our communities firsthand. Hospitals are continuing to experience massive influxes of psychiatric patients to their emergency departments because of poor access to outpatient mental health services. This affects not just the psychiatric patients but all patients in the emergency department. If we can manage psychiatric patients through early stabilization and treatment, we can improve the quality of care and clinical operations so that all patients can be seen faster and more comprehensively,” said Dr. Matt Patlovany, President and Chief Clinical Officer of USACS.

“At Array, we aim to deliver quality and timely behavioral health, using evidence-based tools that meet patients where they are. We’re excited to see how this strategic partnership can help health systems across the nation meet the physical and mental health care needs of their community,” said Dr. Jim Varrell, Executive Chief Medical Officer of Array.

“We at USACS have already demonstrated through our Integrated Acute Care model that emergency medicine, hospital medicine and critical care working together can produce better clinical outcomes for our patients and operational outcomes for our health system partners,“ added Dr. Amer Aldeen, Chief Medical Officer of USACS. “Now, we are excited to partner with the national leader in virtual psychiatric care to ensure that high-quality care includes both physical and mental health.”

About USACS

Founded by emergency medicine and hospitalist physicians across the country, USACS is solely owned by its physicians and hospital system partners. The group is a national leader in integrated acute care, including emergency medicine, hospitalist and critical care services. USACS provides high-quality care to approximately nine million patients annually across more than 500 programs and is aligned with many of the leading health systems in the country. Visit usacs.com for more.

About Array Behavioral Care 

Array Behavioral Care is the nation’s leading clinician-centric virtual psychiatry and therapy practice with a mission to transform access to quality, timely behavioral health care. Array is uniquely positioned to offer virtual behavioral health solutions across the continuum of care, with three flexible delivery models that provide patients and healthcare organizations with timely access to mental health care services regardless of acuity or setting.  For more than 20 years, Array has partnered with hundreds of hospitals and health systems, community health care organizations and payers of all sizes to expand access to care and improve outcomes for underserved individuals, facilities and communities. As an industry pioneer and established thought leader, Array has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.

[1] Simko L, Birgisson N E, Pirrotta E A, et al. (June 02, 2022) Waiting for Care: Length of Stay for ED Mental Health Patients by Disposition, Diagnosis, and Region (2009–2015). Cureus 14(6): e25604. DOI 10.7759/cureus.25604

Two experts with Array Behavioral Care, Scott Baker, VP of Sales, and Dr. Brian Schurgin, Physician Executive, joined Kelly Wisness from Besler’s Hospital Finance Podcast to discuss the clinical and financial impacts of psychiatric boarding in hospital emergency departments and how a comprehensive virtual behavioral care solution can benefit the hospital by decreasing direct costs and enhancing revenue opportunities by moving patients through the ED in an appropriate and timely fashion. Listen here.

If you are in crisis, call 988 to talk with the National Suicide Prevention Lifeline, text HOME to 741741 to connect to a free crisis counselor, or go to your nearest emergency room.