E-Prescribing: Waiver Helpful Hints

Nancy Leveille in Clinical & Quality

Dr. William C. Hallett, Pharm.D, MBA, CGP, President/CEO, Guardian Consulting Services, Inc. recently spoke with the NYS BNE to discuss issues with requesting a waiver. He offered to share information he learned. The following are helpful hints he documented from those discussions with the BNE to assist with the process:

Per their memo, the BNE is requiring in your waiver justification that you:

  1. Provide a detailed description of the economic hardship and/or technological limitations not reasonably in the control of the practitioner and other exceptional circumstances that are relevant; and
  2. Include your sites’

a. current e-prescribing capabilities;
b. the date when those capabilities are expected to be fully operational; and
c. steps that are being taken to meet the e-prescribing mandate; and
d. any other pertinent information related to the request.

The BNE also appears to be looking for 3 core elements in the justification text. It appears that if the points above are covered, and all three of the following elements are satisfied, then the waiver requests are likely to be approved.

Here’s what they are (somewhat re-stating the above):

  1. What E-Prescribing software you are currently using or planning to use;
  2. Why, in your estimation, your E-Prescribing software will either not be ready or is not currently capable of handling the needs of the prescribers at your facility to prescribe and obtain medications for their patients in a timely manner, along with a statement indicating that these are factors not reasonably in control of the institution/practitioners; and
  3. What are your planned efforts to become compliant.

Taking all the above into account, you may want to model and personalize your revised waiver justification text based on the following, which is taken from a facility which had its’ waiver request granted:

“As a skilled nursing facility we utilize our physicians 24/7, specifically when they are not onsite. In addition, we do not have physicians/physician extenders onsite 24/7 and therefore, we will rely on the need to take telephone orders and process orders as traditionally done in the nursing home setting. We currently are utilizing Sigmacare, which does have a built in, e-prescribing module. However, we have found that as we train our providers and delve into the module's complexities, the system presents with technical issues beyond our control. Although we are working diligently towards compliance, we are concerned with the impending time frame, technical concerns and many moving pieces that seem to be out of our control. Although E-Prescribing will help many healthcare providers, it will certainly cause skilled nursing facilities to be faced with increased challenges and possible delays in care”.

IMPORTANT:  Your waiver request appears to be missing the required prescriber attestation forms with the prescriber’s signatures. Please make sure the form you uploaded has the date, the printed name, and the actual signature of each prescriber - then re-upload to your application.

In addition, Dr. Hallett noted that if you can describe your situation using the text boxes vs uploading a letter, it is reviewed a little faster.

If you have any questions, feel free to contact NYSHFA staff.


Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x26