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Substance Use Disorder

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Message from the Department of Human Services (DHS):

Pursuant to Act 73 of 2021 (HB 1861), the suspension of various regulatory provisions under the state disaster emergency declaration that are currently in effect and which were set to expire on September 30, 2021, are now extended until further notice. A list of the regulations that were suspended in whole or in part and their current status is available at Suspended Regulations Lift.

In addition, some regulations were reinstated prior to September 30, 2021 and are not subject to Act 73 of 2021.

Please note that Act 73 of 2021 only affects state regulations that were suspended under the state disaster emergency declaration and were to be reinstated on September 30, 2021. Federal flexibilities provided through the federal public health emergency will remain in place as long as the federal public health emergency remains in effect. The U.S. Department of Health and Human Services (HHS) extended the federal public health emergency on July 19, 2021 to October 17, 2021 (90 days).

RCPA Policy Directors will be reviewing the regulatory status and provide additional guidance and information as it is communicated by the respective DHS Departments, including any special instructions on the reimplementation of any of the suspended regulations. If you have any additional questions, please contact your RCPA Policy Director or your DHS Licensing Office.

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The Department of Drug and Alcohol Programs (DDAP) sent out guidance on June 14, 2021 regarding three temporary regulatory suspensions granted by the governor’s declaration of a disaster emergency due to the coronavirus pandemic. House Bill 1861, which was signed into law today by Governor Wolf, further extends those regulatory suspensions from September 30, 2021 until March 31, 2022 unless terminated sooner. In addition to the suspensions noted in DDAP’s previous communication, one additional regulatory suspension from the Department of State, also relevant to the field, is added to the chart below and also suspended until March 31, 2022.

Statute/Regulation Statute/Regulation Purpose Waiver benefit/explanation
28 Pa. Code § 715.16(e) Prohibits narcotic treatment programs (NTPs–methadone clinics) from permitting a patient to receive more than a 2-week take-home supply of medication. In response to COVID-19, SAMHSA is allowing up to 28 days of take-home medications for patients on stable dosages, if the physician deems appropriate.
28 Pa. Code § 715.9(a)(4) Requires NTPs to make a face-to-face determination before admission to treatment, for those clients who will receive buprenorphine treatment. In response to COVID-19, SAMHSA is allowing initial evaluations for a patient who will be treated with buprenorphine to be completed via telehealth.
28 Pa. Code § 715.6(d) Requires NTPs to have narcotic treatment physician services onsite. In response to COVID-19, SAMHSA is allowing initial evaluations for a patient who will be treated with buprenorphine to be completed via telehealth.
49 Pa. Code § 16.92(b)(1)

(Department of State)

 Before a patient can be prescribed any controlled substance in Pennsylvania, a person licensed to practice medicine and surgery in the commonwealth, or otherwise licensed or regulated by the State Board of Medicine, must take an initial medical history and conduct an initial physical examination,

unless emergency circumstances justify otherwise.

 In response to COVID-19, the Department of State suspended the initial medical history and physical examination requirement specifically for the treatment of opioid-use disorder with buprenorphine.

Please email the Bureau of Program Licensure or call (717) 783-8675 with questions.

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The COVID-19 pandemic has created existential challenges for agencies that provide supports and services to individuals who have disabilities and/or health issues. Staffing has been an area that has been significantly affected. Legislative and State Stakeholders have requested RCPA to quantify the impact of the pandemic on our workforce so that we might effectively lobby for the welfare of the agencies that support and serve individuals with disabilities and health issues.

We recently distributed a work force survey to our members that did not include a section specifically to address the issues support coordinators in the IDD, MH, and OLTL fields are facing. The SC Workforce survey asks questions specifically directed to the challenges that supports coordinators, or service coordinators, are experiencing.

If you have already completed the survey that was released last week, please do not complete this survey. We will extract the data from your submission to add to the data collected here.

The survey responses seek to gather data related to hiring, retention, vacancy rates, pay structures, vaccinations, and COVID-19 impacts on programs as well as access to care associated with the pandemic.

RCPA is making the survey available to providers across Pennsylvania, not just RCPA members. Please be assured that response data will be de-identified and aggregated for reporting by an independent research entity, and your individual data will be shared with no one. A copy of the results of this survey will be available to all participants at the conclusion of the study.

We thank you in advance for your time in completing this survey and would ask that you share this information with your colleagues, fellow leaders, and Human Resources teams. The more information collected, the more we will be able to provide to stakeholders, which will affect not only RCPA members but all providers within the Commonwealth.

If you have any questions, please contact Director of Intellectual Disability Services Carol Ferenz or your RCPA Policy Director.

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The Federal Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has announced a new application cycle for $25.5 billion in COVID-19 provider funding. Applicants will be able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

The application is open now and will close on October 26, 2021 at 11:59 pm ET. Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application. In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.

Technical Assistance Webinars
HHS recently hosted a briefing session to provide information about these upcoming funding opportunities – view the video. HRSA will be hosting webinar sessions for Phase 4 and ARP Rural applicants, featuring guidance on how to navigate the application portal.

Real time technical assistance is available by calling the Provider Support Line at (866) 569-3522, for TTY dial 711. Hours of operation are 8:00 am–10:00 pm CT, Monday through Friday.

RCPA will continue to monitor this new round of funding and update members on the implementation process. If you have questions, please contact your RCPA Policy Director.

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Source: Spotlight PA, Sept. 29, 2021

HARRISBURG — The Pennsylvania legislature unanimously voted Wednesday to extend dozens of regulatory waivers put into place last year to help health-care providers fight COVID-19.

Without action, the waivers would have expired Thursday, potentially exacerbating ongoing staffing crises in hospitals and long-term care institutions, which are again facing rising COVID-19 cases. Health-care workers and their advocates had warned any lapse in the relaxed rules would have renewed administrative burdens and made fighting the ongoing pandemic more difficult.

Wednesday’s action will keep the waivers in place until March 2022 while the legislature considers a number of bills that would make the regulatory suspensions permanent. Gov. Tom Wolf will sign the bill.

“The governor is thankful the legislature engaged the administration and stakeholders and ultimately agreed with most of the administration’s recommendations on extending COVID-19-related waivers that are still in use,” spokesperson Lyndsay Kensinger said.

At the beginning of the pandemic, Wolf approved nearly 100 waivers to ease some of the rules governing health-care workers and ensure as many professionals as possible were on the ground in hospitals, vaccination clinics, and long-term care facilities.

The temporary changes were made under a disaster declaration that later became a target for legislative Republicans unhappy with the administration’s business closures.

Buoyed by two successful constitutional amendments that curtailed the executive’s power, the GOP-controlled General Assembly ended Wolf’s emergency order in June, while allowing the waivers to remain in place until Sept. 30.

Under the bill passed Wednesday, all suspensions under the Department of Health, Department of Human Services, and the Bureau of Professional and Occupational Affairs will remain in place until March unless Wolf and the agencies decide to terminate them sooner.

Among the waivers extended are those allowing out-of-state practitioners to treat patients in Pennsylvania, permitting retired or lapsed professionals to return to medicine, and expanding who can give a vaccine.

The waivers also allow patients to access care via telemedicine, which as of now is neither allowed nor prohibited in Pennsylvania law, creating a gray area for health-care providers and insurance companies.

Lawmakers have introduced bills in both the House and Senate to provide rules and regulations surrounding telemedicine, but past efforts have broken down over partisan disagreements. Wolf vetoed a telemedicine bill last year because it would have prevented health-care providers from prescribing abortion-inducing medicine.

As a number of other bills that would make regulatory suspensions permanent await consideration, two removing administrative barriers for physician assistants passed Wednesday.

The Joint State Government Commission is studying the impact of the waivers and which should stay in place to remove barriers to employment in the state. Glenn Pasewicz, executive director of the committee, said a report should be out by late October.

Separately, lawmakers on Wednesday directed various state agencies to post a report listing which waivers were and were not extended by Nov. 1.

RCPA will continue its efforts with DHS to determine the status of any waivers that may not fall under this regulatory extension. Please contact your RCPA Policy Director if you have any questions.

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ANCOR Urges All Members to Take the Following Action:

The Ask: Use our action tool to insist that your members of Congress fully fund the $400 billion investment in Medicaid Home and Community-Based Services (HCBS) in the budget reconciliation package.

The Details: Congress is currently negotiating its budget reconciliation bill, which could include an investment of billions of dollars in the HCBS program. The House version of the bill included $190 billion in the HCBS program, falling far short of the promise President Biden made in his American Jobs Plan to invest $400 billion in HCBS and failing to meet the funding level outlined in the Better Care Better Jobs Act.

While we celebrate this historic investment in the HCBS program, the level of financing is insufficient to sustain access and stabilize the direct care workforce. The dire conditions facing our nation’s direct care workforce demand a greater investment.

Why It Matters: A $400 billion investment in dedicated support for HCBS is essential for building a sustainable HCBS infrastructure that can begin addressing the magnitude of unmet need in our communities, and frankly, increased funding for HCBS can’t wait any longer. Not only does investing in this program enjoy wide bipartisan support—81% of voters want to see this funding in the reconciliation bill—but ANCOR’s recent research shows how badly community services need resources to stabilize a workforce in crisis.

Our new report, The State of America’s Direct Support Workforce Crisis 2021, reveals deep concerns from our providers, including:

  • 92% of providers report that the pandemic continues to inhibit their ability to recruit and retain workers; the majority of these respondents point to the fact that industries that previously paid comparable wages now pay employees more than they can afford to do.
  • 77% of providers have had to stop accepting new referrals due to high turnover or lack of staff.
  • 58% of providers have had to discontinue programs or services due to high turnover or lack of staff.
  • 84% of providers have had to delay the launch of new programs or the opening of new homes due to high turnover or lack of staff.
  • 81% of providers report difficulties achieving required quality standards due to high turnover or lack of staff.

The findings of this survey reveal the significant need for an immediate federal response. As the House and Senate continue to move this historic legislation and enter negotiations on the final package, it’s essential that every member of Congress hears from you now.

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Capitol hill building in the morning with colorful cloud , Washington DC.

Message from ANCOR: 

Dear ANCOR Members,

The to-do list for Congress this week is quite massive and hugely significant. Speaker Pelosi’s list includes passing the bipartisan infrastructure package, the reconciliation, and a continuing resolution (CR) to fund the government. We wanted to give you a Monday overview of what we are following, planning and how you can help in the coming days!

First up, the Continuing Resolution or CR: If you’ll recall, the House did pass a CR, but it included provisions to raise the debt limit, disaster relief funding and Afghanistan refugee resettlement funding. The Senate is not going to pass the CR with all of that attached. There should be a party line vote today, primarily with Republicans refusing to raise the debt limit. (This is a drama that plays out in Congress all the time, no matter the party in power…haven’t we all seen this movie before?) Once that Senate vote fails today, both chambers will need to go back to the drawing board in order to pass a “clean” CR that can be signed by President Biden by midnight on September 30 to avoid a government shutdown.

Next up, the Bipartisan (hard) Infrastructure Package: Speaker Pelosi announced the House will vote on this package Thursday, September 30. Originally the date was set for a vote on both this package and the human infrastructure package TODAY in hopes of keeping both the progressive and moderate sides of her caucus satisfied, but things haven’t gone exactly to plan. The risk for Speaker Pelosi is that the progressive caucus has threatened to vote no on the bipartisan infrastructure package without significant progress toward the reconciliation package (where our HCBS funding lives). Speaker Pelosi has promised a “framework” for the reconciliation package in hopes that will be enough to bring the progressives on board to pass the bipartisan package first, but the vote is anything but certain.

Last but not least, the Human Infrastructure Package/Reconciliation: On Sunday, the House Budget Committee (after the markups) packaged the reconciliation bill and moved it to the House Rules Committee. As expected House and Senate Democrats are actively negotiating to develop an overarching framework and legislative text. Leadership is developing a reconciliation package for a potential vote on Thursday in hopes of moving the progressive Democrats to vote on the bipartisan package (see above).  Needless to say, this is a tall order to get this done by Thursday with so many disagreements among Democrats on what should and shouldn’t be included. One thing for sure, whatever happens this week with the reconciliation will not be the last step. There will still be plenty of time for change.

LASTLY, WHAT CAN WE DO TO HELP?

  • Recent polling shows over 80% of Americans support the HCBS provisions of the bill, even if they don’t agree with other parts of it.
  • Congress is hearing from a LOT of their constituents back home supporting HCBS. Keep it up! This is clearly not a partisan issue.
  • Tell your stories!
  • Take Action Alerts!

On Wednesday, ahead of the vote(s) in the House…we will be releasing a summary brief of our recent Workforce Impact Survey, along with a NEW Action Alert. Please be on the lookout for that, rally your groups and prepare for this important DAY OF ACTION. 

Thank you, everyone! Happy Monday!
——————————
Shannon McCracken
Vice President of Government Relations
ANCOR
606.271.3555
——————————

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Message from Centers for Medicare and Medicaid Services (CMS):

Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and Most Commercial Health Insurance Coverage.

Following the FDA’s recent action that authorized a booster dose of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the CDC, CMS will continue to provide coverage for this critical protection from the virus, including booster doses, without cost sharing.

Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance, or deductible. In addition, thanks to the American Rescue Plan Act of 2021, nearly all Medicaid and CHIP beneficiaries must receive coverage of COVID-19 vaccines and their administration, without cost-sharing. COVID-19 vaccines and their administration, including boosters, will also be covered without cost-sharing for eligible consumers of most issuers of health insurance in the commercial market. People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.

“The Biden-Harris Administration has made the safe and effective COVID-19 vaccines accessible and free to people across the country. CMS is ensuring that cost is not a barrier to access, including for boosters,” said CMS Administrator Chiquita Brooks-LaSure. “CMS will pay Medicare vaccine providers who administer approved COVID-19 boosters, enabling people to access these vaccines at no cost.”

CMS continues to explore ways to ensure maximum access to COVID-19 vaccinations. More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available on the CDC COVID-19 Vaccination Program Provider Requirements and Support webpage and through the CMS COVID-19 Provider Toolkit.

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As your teams begin working on completing the RCPA Work Force Survey, we received a request to have a master list of questions that can be referenced. The Master List of survey questions includes all service line areas, questions on the program operations, and vaccinations.

Again, we thank you for your efforts to complete the survey. Please contact RCPA Children’s Division Director Jim Sharp if you have any questions or concerns.

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