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Authors Posts by Jim Sharp

Jim Sharp

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As part of the Centers for Medicare & Medicaid Services’ (CMS) ongoing efforts to provide up-to-date information to prepare for the end of the Public Health Emergency (PHE) for COVID-19, expected on May 11, 2023, we are providing a new overview fact sheet on CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency. COVID-19 efforts have been a significant priority for the current administration, and with the use of whole-of-government approach, the country is in a better place. Over the next several months, CMS will work to ensure a smooth transition back to normal operations.

The fact sheet provides clarity on several topics, including:

  • COVID-19 vaccines, testing, and treatments;
  • Telehealth services; and
  • Health care access.

There are several telehealth flexibilities listed within the document, including the continuation of virtual supervision to the end of the calendar year. See below for an excerpt from CMS’ PHE release:

Virtual Supervision

To allow more people to receive care during the PHE, CMS temporarily changed the definition of “direct supervision” to allow the supervising health care professional to be immediately available through virtual presence using real-time audio/video technology instead of requiring their physical presence. CMS also clarified that the temporary exception to allow immediate availability for direct supervision through virtual presence also facilitates the provision of telehealth services by clinical staff “incident to” the professional services of physicians and other practitioners. This flexibility will expire on December 31, 2023.

What is missing is guidance around the intersect of telehealth and the prescribing of buprenorphine as directed under the Ryan Haight Act of 2008. As part of the CMS Physicians Fee Schedule of 2023, CMS was in the process of writing language extending this as a flexibility. To date, there has been no guidance, though RCPA continues its advocacy efforts with the National Council for Mental Wellbeing, as well as state and federal stakeholders.

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As the Federal Public Health Emergency unwinds, more than a million Pennsylvanians on the Medicaid rolls will have their eligibility determinations reviewed. RCPA has been a part of the MA/CHIP Watch Group, an advocacy partnership focused on this process for children and families to ensure coverage for services. The partnership is a group of Pennsylvania health, law, and policy advocates who work directly with and on behalf of Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) enrollees. For approximately one year, the group has been meeting regularly with DHS staff to discuss DHS’ plans to resume regular operations when the federal provision for continuous coverage, put into place in March 2020 at the onset of the COVID-19 pandemic by the Families First Coronavirus Response Act (FFCRA), ends.

DHS has an unprecedented task ahead: conducting MA eligibility checks for an estimated 1.1 million MA enrollees, who either no longer appear to be eligible or have overdue renewals. The group remains very concerned about the enormous administrative workload the County Assistance Offices (CAOs) will face when redetermining eligibility for this large volume of cases while resuming regular operations after three years, and how that is likely to translate into individuals losing coverage, though remaining eligible.

Recently, the group presented a letter of recommendations to DHS Secretary Dr. Val Arkoosh outlining these concerns and pathways to ensure transitional care and coverage for children. Additionally, RCPA in their meetings with DHS continues its advocacy and support for the recommendations outlined in the letter to Secretary Arkoosh.

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The sustained funding of community-based mental health services, such as community residential programs, family-based support, outpatient care, and crisis intervention, are critical to the wellbeing of our constituents and our communities. Funding levels for county mental health services have direct impacts on whether these important community and family supports will be available. Yet for too many years, state funding for mental health services has lagged far behind its needs. Counties find themselves advocating for the prevention of funds being cut instead of achieving the increases that are needed to catch up from years of underfunding.

This year, RCPA and other system stakeholders once again teamed with the County Commissioner Association of Pennsylvania (CCAP) through the Mental Health Safety Net Coalition. The mission and vision of this campaign continues to promote awareness of the critical funding needs of mental health services for vulnerable Pennsylvanians. As RCPA and the Mental Health Safety Net Coalition continue our efforts, we ask our members, stakeholders, and partners to join us in this collaborative effort by engaging with your legislators. “County mental health services provide a critical piece to the public safety net for people in need,” notes Richard S. Edley, PhD, President and CEO of RCPA. “The system sustained cuts over a decade ago with little relief since then. It is time to restore those dollars and further enhance the system. Not only will it provide critical funding for the individuals receiving services, but there are positive benefits — both financially and clinically — to the entire community.”

The Coalition welcomes the many new partners for this 2023–24 initiative, as the time to act is now for engaging with your representative. Local communities and providers have come together to sustain the safety net and serve those who need it most. The reality is that the demand for service far outweighs capacity and rate structures to serve this population.

View our first of many communications that will go out on behalf of the Coalition as an open call to the PA General Assembly and stakeholders. This will provide you with strategic talking points for our outreach. If you have additional questions or would like to join the Mental Health Safety Net Coalition, please contact RCPA Policy Director Jim Sharp.

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The Dennis Marion Impact Award recognizes local and state government employees whose initiatives, processes, and projects have led to significant improvements in Pennsylvania’s behavioral health service delivery system.

Background:
The Dennis Marion Impact Award was established in 2017 in honor of Dennis Marion’s commitment to public service throughout his distinguished career, which spanned over three decades. Dennis served as Deputy Secretary for Pennsylvania’s Department of Human Services’ Office of Mental Health and Substance Abuse Services from 2013 to 2017. Prior to his state employment, Dennis served Cumberland County, Pennsylvania for 31 years in various positions, such as County Administrator, Director of the Drug and Alcohol Commission, and Director of the Office of Mental Health and Intellectual Disabilities.

Just like Dennis Marion, whose strong leadership, passion for public service, and commitment to the people he served did not stop at the boundaries of his work in any single county or agency, the Dennis Marion Impact Award recognizes strong performers who bridge disparate missions and drive towards a single goal of excellence in public service.

Purpose:
The purpose of the Dennis Marion Impact Award is to recognize outstanding and meritorious achievement in working for state or local government, encourage the highest standards of performance in Pennsylvania’s public sector, attract outstanding individuals to a career in public service, and highlight public awareness of the value of public service and its impact on the behavioral health and quality of life of individuals and communities.

Eligibility Criteria:
Any current state and/or local government employee in Pennsylvania that has made an outstanding contribution in the area of behavioral health (mental health and/or substance use disorders) in Pennsylvania is eligible for nomination for the Dennis Marion Impact Award. Individuals that have built effective, collaborative partnerships across different organizations, agencies, and/or other stakeholders to define and solve problems, or reach agreements on a course of action, will be given priority consideration for this award.  Nominees’ contributions may be on a sustained basis or through a single, exceptional accomplishment. Nominations will be judged on three measurements: innovation, implementation, and outcomes.

Instructions:
The completed nomination form must be submitted electronically to Lindsay Graves via email by 5:00 pm EST on March 24, 2023. The nomination period is open from February 17, 2023, to March 24, 2023.. Nominations will not be accepted before or after the nomination period. Note that individuals may not self-nominate.

The award will be announced during Pennsylvania’s May 2023 Mental Health Awareness Month events. Questions regarding this award may be directed to Lindsay Graves via email.

Sponsoring Organizations:
Pennsylvania Department of Human Services — Office of Mental Health and Substance Abuse Services
Mental Health Association in Pennsylvania
Pennsylvania Association of County MH/DS Administrators
Rehabilitation and Community Providers Association
Pennsylvania Association of County Drug and Alcohol Administrators
Pennsylvania Mental Health Consumers’ Association

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Photo by Markus Winkler from Pexels

Laval Miller-Wilson will join the Pennsylvania Department of Human Services (DHS) on Monday, March 13 as the Deputy Secretary for the Office of Children, Youth, and Families (OCYF), which supervises the county-operated child welfare and juvenile justice systems. Miller-Wilson, an attorney, is deeply committed and passionate about ensuring that vulnerable populations get the care they need and deserve.

Miller-Wilson has been the Executive Director of the Pennsylvania Health Law Project (PHLP) since 2009, a non-profit that protects and advances health care rights through free legal services, community education, and systems advocacy. At PHLP, he worked to make the health industry and policymakers more attuned to what people want and need — and more accountable for making it happen. He was lead counsel for Medicaid enrollees on Pennsylvania’s Medical Assistance (Medicaid) Advisory Committee, which advises the Commonwealth on the impact of current and proposed Medicaid policies and practices. He delivered consumer-informed perspective about the state’s implementation of the Affordable Care Act, performance of Medicaid managed care plans, and determinants of health.

Prior to joining PHLP, Miller-Wilson worked for 14 years at Juvenile Law Center (JLC) representing children in the child welfare, juvenile, and criminal justice systems. At JLC, he led their 2008 petition to the Pennsylvania Supreme Court to ensure accused youth in Luzerne County had the right to counsel (subsequently known as the “Kids for Cash” scandal), and federal litigation to improve the delivery of basic and special education to children in the criminal justice system. He was also the lead author of a 2003 assessment of children’s access to counsel and the quality of representation they receive in Pennsylvania’s juvenile justice system that required surveying and visiting juvenile courts across the Commonwealth.

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