ECHO Idaho X-Waiver Training Information
ECHO Idaho is partnering with the Providers Clinical Support System (PCSS), led by the American Academy of Addiction Psychiatry and a large coalition of national professional organizations, including DATA 2000 organizations, the American Psychiatric Association and the American Osteopathic Academy of Addiction Medicine, to provide free X-waiver trainings.
In this two-part training, participants first take a live (in person or via Zoom videoconferencing) four-hour training through ECHO Idaho and then complete a four-hour online self-study portion through PCSS. Once both portions of the training are completed, eligible providers can apply for their DATA 2000 Waiver to prescribe and dispense opioid dependency medications to more than 30 patients.
Live Portion Training Logistics
The training is done in a half-live and half-online format. The first four hours of the training are live, and you can join this portion either in person or via videoconferencing (Zoom) from a computer or smartphone. If you join via videoconferencing, you must have a webcam turned on and focused on you for the entire training so we can verify your attendance. The second portion of the training consists of a 4-hour online self-study portion you complete on your own schedule. At the end of the online modules, you must pass an exam with 75% or higher and complete a survey from PCSS in order to receive your certificate of completion.
The live portion of the training is four hours followed by four hours of self-paced online modules. Providers are eligible to apply for their X-waiver (DEA-X number) to prescribe buprenorphine to more than 30 patients after meeting this eight-hour training requirement. Physician assistants (PAs) and advanced practice registered nurses (APRNs - NP/CNM/CNS/CRNA) must complete 16 additional hours of online training before they can apply for their waiver to prescribe buprenorphine to more than 30 patients. APRNs and PAs do not have to take the trainings in any particular order. However, they both must complete 24 hours of specialized training (one, eight-hour training—i.e., the half-and-half training by ECHO—and a 16-hour training) in order to become eligible to apply for their waiver to prescribe buprenorphine to more than 30 patients.
You must attend all four hours of the live training. If you miss any part of the live training, you are not yet eligible to apply for the waiver or receive the link to the online modules.
The training is free through PCSS and ECHO Idaho! The additional 16-hour X-waiver course is also offered at no cost through PCSS.
Registrations are preferred because it helps coordinate day-of logistics. However, we do accept day-of attendees.
Complete the RSVP form. You will receive an email confirmation once your registration is received.
Email email@example.com or call 208-364-4569 to let the event coordinator know you are unable to attend. Then, watch our website for the next training date!
Join the first half via videoconference and webcam using a free software called Zoom from a computer or smartphone. If you are new to Zoom, contact us at firstname.lastname@example.org or 208-364-4569 and we can help you get it figured out. You can also join in person at the University of Idaho Water Center Building, room 212, 322 E Front St, Boise, ID 83702. Parking information and other logistics will be included in your registration confirmation email.
Yes! You are eligible to earn the X-waiver through this training. NPs, CNMs, CRNAs, CNSs, and PAs must complete 24 hours of specialized training before applying for their waiver. The Half and Half X-Waiver Training offered through ECHO counts toward the eight-hour requirement. After completing the eight-hour requirement, you will then need to complete a 16-hour course, which can be found at PCSS, or contact email@example.com for assistance. The eight-hour and 16-hour trainings can be taken in any order.
Medical residents can complete the X-waiver training at any point in their studies. Once you complete the eight-hour training, you will receive a certificate of completion that does not expire. Medical residents are eligible to apply for their waiver after they have their DEA number and an unrestricted medical license.
PA and ARNP students can complete the X-waiver training at any point in their studies. Once you complete the eight-hour training, you will receive a certificate of completion that does not expire. Students are eligible to apply for their waiver after they have their DEA number.
Yes! We welcome everyone who wants to audit the training for their own professional development, even those who are not eligible or interested in earning their X-waiver. Pharmacists, counselors, and health educators working in clinics where medications for opioid use disorder are dispensed have audited past trainings. Additionally, providers who already have their X-waiver are welcome to attend this training as a refresher course.
You do not need to complete an attendance sheet. ECHO Idaho staff will complete this on your behalf.
You must complete all the live portion of the training to be eligible to get the online portion of the training (for both waiver and non-waiver seekers). A few days following this training, you will receive an email from PCSS with the link to the modules to the email address you listed on your registration. (Use only this one email address for your entire waiver training.) This email will not come from ECHO Idaho; it will likely be from an EXAMPLE@aaap.org email account. Please check your spam/junk folder if you do not receive an email from PCSS. If you have checked your spam folder and have not received an email for the online modules within one week of completing the live portion of the training, please email firstname.lastname@example.org with a CC to email@example.com.
APRNs and PAs can complete the additional 16 hours of training at any time. However, you must still complete the live portion of the training before you can access the remaining four hours of online modules to complete the eight-hour training requirement.
Yes. Anyone who completes all the live training will receive the link to complete the online modules.
Yes. There is no cost for any part of this training through ECHO Idaho and PCSS.
You are encouraged to complete the online modules and pass the exam at the end within 90 days of receiving email follow-up instructions from PCSS.
Continuing Education (CE) Credit Information
During the training, a link to eeds, our online training CE platform, and the session-specific code will be shared in the chat. This information will be used to request and access your CME certificate. Note: Partial CE credit will be awarded in 0.25 increments for the live portion of the training.
The University of Idaho, WWAMI Medical Education Program is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The University of Idaho, WWAMI Medical Education Program designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
You will also receive a CME post-session feedback survey three to six months after the training.
Once you complete the training, you will receive an email from PCSS containing your certificate of completion for the full eight-hour training as well as your CE certificate for the online portion. Note: Partial CE credit will not be awarded for the online portion.
Yes, you are able to receive CE commensurate to the extent of your participation in the live portion (partial credit available in 0.25 increments). The online portion provides four hours of CE, but all components of the training must be completed in order to be awarded credit. Partial credit will not be awarded for the online training.
Applying for the X-Waiver
Providers that are waiver eligible include:
- Physician (MD, DO)
- Advanced Practice Registered Nurse (APRN: NP, CNS, CRNA, CNM)
- Physician Assistant (PA)
Yes. To qualify for the waiver, APRNs and PAs must complete a total of 24 hours of training. This means that in addition to the eight hours earned through the ECHO Idaho/PCSS X-Waiver Training, you will need an additional 16 hours of training. There are many ways to complete the additional 16 hours of training, including free online opportunities at PCSS or through the American Society of Addiction Medicine.
No, your certificate of completion does not expire. You can apply for the waiver any time after you receive your certificate of completion.
If you have completed the live portion of the training, all the online modules and post-module exams, and the PCSS survey and have not received your certificate of completion, complete the request form.
Before you begin, make sure you have your DEA number, state medical license number and your training certificate of completion.
Go to the Buprenorphine Waiver Notification page and answer all of the questions.
- AAAP is considered the accrediting agency.
- For the date of completion, you will put the date of the live (ECHO) portion of the X-waiver training.
After you complete the waiver notification, you will email your training completion certificate to firstname.lastname@example.org (as directed on the waiver notification home screen) and to email@example.com (as directed by PCSS).
Once SAMHSA has received all of your documentation, the process may take up to 45 days for review and approval. You will receive notification via email if approved.
For more information, contact the SAMHSA Center for Substance Abuse Treatment’s Buprenorphine Information Center at 866-287-2728 or email firstname.lastname@example.org.
If approved, you will receive a letter via email from email@example.com with the subject line “Buprenorphine Information Center/Waiver Notification Information” that confirms your waiver and includes your prescribing identification number. DEA regulations require this number to be included on all buprenorphine for opioid use disorder.
While possible, we do not recommend it. As stated on the SAMHSA website, “To receive permission to provide treatment while a notification is under review, check the box ‘New Notification, with the intent to immediately facilitate treatment of an individual (one) patient’ on the notification form. Checking the ‘immediate’ box is only one of three requirements a practitioner must meet in order to start a patient on treatment, and immediate treatment is limited to one patient per form submitted. Each form must have a different submission date. Other requirements the applicant must address include:
- Meeting ‘in good faith’ the criteria for obtaining a waiver such as having a valid medical license, valid Drug Enforcement Administration (DEA) registration, qualified or completion of eight hours of qualifying training.
- Contacting CSAT's Buprenorphine Information Center at 866-BUP-CSAT (866-287-2728) to verify that the notification form has been received and to notify CSAT of the practitioner’s intent to begin treating one patient.
Since the practitioner will not have a unique identifying number, pharmacists may question prescriptions received under this provision. Pharmacists may contact SAMHSA, if additional information is needed, at 866-BUP-CSAT (866-287-2728) or by sending an email to firstname.lastname@example.org.
General X-Waiver Information
The X-waiver is commonly known by several names:
- Bupe (Buprenorphine) waiver
- DATA (Drug Addiction Treatment Act) waiver
- X-waiver (for the X that will be added to your DEA license when you receive the waiver)
- DATA 2000 waiver (named as such because 2000 is the year the Act was passed)
- MAT waiver: MAT stands for Medication for Addiction Treatment, previously known as Medication Assisted Treatment
You can treat up to 30 patients the first year you have your waiver.
After one year, you can apply for a patient limit increase by using the buprenorphine waiver notification form to treat up to 100 patients. There are no additional training requirements to apply for a patient limit increase.
After you hold the 100-patient waiver for one year, you can apply for a 275-patient waiver (by using the buprenorphine waiver notification form) if you have additional credentialing or work in a qualified practice setting. More specific information on board certifications and qualified practice settings can be found in question two of this FAQ document from the American Society of Addiction Medicine (ASAM).
Do not prescribe to the higher patient limit until you receive SAMHSA approval.
“Certain board certifications” include a board certification in addiction medicine or addiction psychiatry by the American Board of Addiction Medicine, the American Board of Medical Specialties or the American Society of Addiction Medicine.
As defined by SAMHSA, a qualified practice setting is a setting that:
- Provides professional coverage for patient medical emergencies during hours when the practice is closed;
- Provides access to case management services for patients, including referral and follow-up services for programs that provide or financially support medical, behavioral, social, housing, employment, educational or other related services;
- Uses health information technology if it is already required in the practice setting;
- Is registered for their state prescription drug monitoring program where operational and in accordance with federal and state law; and
- Accepts third-party payment for some services, though not necessarily for buprenorphine-related services and not necessarily all third-party payers.
You must complete the buprenorphine waiver notification form to apply for an increase to your patient limit. There are no additional training requirements to apply for a patient limit increase.
After you complete the form, you will receive a confirmation email that your request has been received. You must reply to this email to complete the submission process, and you will receive a second notification submission acknowledgement by an emailed letter.
You must submit an annual report to SAMHSA, which is due before the anniversary of your waiver renewal date. If SAMHSA does not receive this report, your 275-patient limit is automatically rescinded to the 100-patient level. You must also coordinate with anyone beyond the 100-patient limit to direct him or her to a new treatment resource because of your reduced patient capacity.
You must practice according to nationally recognized evidence-based guidelines and have a diversion control plan. Additional information can be found on the ASAM website.
For PAs, according to the Idaho State Board of Medicine, “The Supervising Physician to a PA with an X-waiver needs to have an X-waiver, too. Each PA needs to practice within the scope of his or her Supervising Physician, and that physician would need to have the waiver (trained) to know if the PA is practicing safely.”
The Comprehensive Addiction and Recovery Act of 2016 also addresses this subject here.
Only prescribers approved to treat 275 patients must renew their waiver. To renew the patient limit increase after the three-year approval term, practitioners must submit a renewal request, which includes the same information that is required for an initial patient limit increase request. The renewal request must be submitted at least 90 days before the expiration of the previous approval term. If SAMHSA does not reach a final decision on the renewal request before the expiration of the previous approval term, the approval term will be extended until SAMHSA reaches a final decision.
Yes, SAMHSA reserves the right to deny a waiver renewal for prescribers approved to treat 275 patients. In the event of a renewal, you must stop prescribing buprenorphine immediately; there is no grace period for the transfer of patients.
Patients receiving any formulation of buprenorphine for treatment of an opioid use disorder, including implantable and injectable buprenorphine, count toward the patient limit. These patients can be in different locations.
No. The buprenorphine waiver is federal and just gives you a second DEA number that starts with an X.
According to the Idaho State Board of Medicine, merely seeking treatment for OUD is not a basis to report. Providers need to report either themselves or other providers (MD, DO or PA) only if they believe there has been a violation of the Medical Practice Act. (A provider with OUD still seeing patients is not necessarily a violation of the Medical Practice Act.) If a provider believes that their OUD causes them to be unable to provide safe patient care or care that does not meet the community standard of care, then that provider must report him or herself to the Board. Failure to do so may lead to further discipline for the failure to report. Please note that the Board has a Disabled Physician Act within its Practice Act that gives the Board a non-disciplinary way to work with physicians or PAs who are disabled by their substance use issues. Similarly, if a licensee becomes aware that another licensee is unable to provide safe care, meet the community standard of care or has otherwise violated the Medical Practice Act, then that licensee has a duty to report that other licensee to the Board or possibly be disciplined for failure to do so despite knowing of the Practice Act violation. For more information, contact the Idaho State Board of Medicine.
ECHO Idaho sessions on Opioid Addiction and Treatment provide a wealth of information and real-time connection to other clinicians and providers across Idaho. You can also find recordings of past sessions and a list of ongoing resources.
As of September 16, 2019, Idaho had 437 X-waivered providers, but it is unclear how many use their waiver.
- 356 can treat up to 30 patients
- 244 MD/DO
- 79 APRN
- 33 PA
- 66 can treat up to 100 patients
- 45 MD/DO
- 19 APRN
- 2 PA
- 15 can treat up to 275 patients
- 15 MD/DO
Additional X-waiver information can be found on the SAMHSA website.
If you have questions about accessing the online portion of the PCSS X-Waiver Half and Half Waiver Training or retrieving your certificate, please email email@example.com.
Ask us! Please email your question to firstname.lastname@example.org or call 208-364-4569.
ECHO Idaho is led by the University of Idaho, the WWAMI Medical Education Program, and its X-Waiver training program is supported in part under Grant No. 2018-PM-BX-K123 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice’s Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.