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Substance Use Disorder

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The Department of Drug and Alcohol Programs (DDAP) has issued Licensing Alert 03-2024, effective immediately, which introduces updated guidance on complying with Act 66 of 2023, signed into law by Governor Shapiro in December. The guidance specifically outlines all regulatory flexibilities for SUD treatment facilities enabled through the law and describes the process for project directors to notify DDAP of their intent to use any of these flexibilities. In part, Act 66 allows:

  • An increase in staff-to-client ratio for adult nonhospital residential treatment and rehabilitation programs, from 1:8 to 1:12;
  • Certified Registered Nurse Practitioners (CRNP) and Physician Assistants (PA) to serve as counselors;
  • Individuals lacking previous clinical experience to still qualify as counselors if they possess a bachelor’s or associate degree in relevant fields or hold a current Registered Nurse license; and
  • Facilities to hire up to three counselor assistants for each staff person meeting clinical supervisor or counselor qualifications.

Additionally, the alert underscores the importance of continued compliance with other regulations, such as clinical supervisor ratio requirements, counselor assistant supervision, and evaluation requirements. For additional questions, contact the Bureau of Program Licensure.

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Photo by Markus Winkler on Unsplash

The Department of Drug and Alcohol Programs (DDAP) has issued Licensing Alert 02-2024, effective immediately, to inform opioid treatment programs (OTP) about the recent final rule issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) on February 2, 2024, concerning medications for the treatment of opioid use disorder (OUD). RCPA issued an alert to its members on February 1 announcing the final rule.

This rule modifies and updates regulations pertaining to OTP accreditation, certification, and standards for the treatment of OUD. The most crucial aspects of SAMHSA’s final rule include the permanent adoption of COVID-19 era flexibilities, allowing patients to receive more take-home doses of methadone, which is proven to enhance treatment retention and reduce illicit opioid use. The update also permits the initiation of methadone and buprenorphine treatment via telehealth through OTPs and removes stringent admission criteria, thereby improving access to care for individuals in need.

DDAP is currently reviewing the final rule, set to take effect on April 2, 2024, with a compliance deadline of October 2, 2024, and plans to issue a follow-up Licensing Alert soon. For further information, contact the Bureau of Program Licensure.

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Last week, Governor Shapiro presented his proposed budget for 2024/2025. The PowerPoint with the Human Services Spending Overview outlines the priorities, and the recording is available on the DHS YouTube channel.

RCPA staff will continue to advocate for appropriate levels of funding for our members’ services in the community. We will keep you updated with information as the process continues. If you have any questions, please contact your RCPA Policy Director.

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RCPA is pleased to report several successful collaborative efforts this week, including a meeting with DHS, OMHSAS, and a delegation of House and Senate Representatives. We reviewed proposed language for a new bill that would address the 4 walls standard for ongoing telehealth with practitioners not within the 4 walls of a clinic. The bill will also include language previously introduced on the Psychiatric Outpatient Regulatory requirements for the 50% in-office time for clinics and the use of advanced practice professionals to meet those time requirements.

The language for both target areas was approved by all parties and will now move on to the House Human Services Committee. RCPA has a meeting scheduled for early next week to review the finalized version prior to its introduction. We have also met with Senate counterparts to support the measure.

Lastly, RCPA continues its dialogue with OMHSAS for guidance and clarification, including sharing members’ and stakeholders’ feedback. We have had the opportunity to speak with our BH-MCO members and understand OMHSAS Deputy Secretary Jen Smith will be meeting with that group and the county contractors on the processes moving forward.

We are hopeful for an expedited legislative solution that will aid OMHSAS in making any resulting policy, practice, or program changes that will support the initiative. We are extremely encouraged by the system’s efforts and focus this week and will continue to provide key updates to members and stakeholders.

If you have any questions, please contact RCP Policy Director Jim Sharp.

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The Department of Human Services (DHS) just announced that, due to reaching capacity in the February 9 meeting, they are adding a second session at 1:30 pm on the same day. If you are already registered for the morning session, do not register for the afternoon session so that they can keep enough space for all who are interested. Both sessions will be recorded and posted publicly to YouTube, and content will be roughly similar within the two sessions. DHS will share Question and Answer (Q&A) sessions from both, and a follow-up Q&A document will be shared next week.

Visit here to register for the afternoon session.

(If the registration link above does not work, please try copying this link directly into your browser: https://events.gcc.teams.microsoft.com/event/9f3d9e64-6d38-45a7-84eb-b0ae2b1aafd9@418e2841-0128-4dd5-9b6c-47fc5a9a1bde)

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The Pennsylvania Commission on Crime and Delinquency (PCCD) announces the opening of registration for the 2024 Criminal Justice Advisory Board (CJAB) Conference, themed “An Evolving Justice System: Adapting and Navigating New Directions.” The conference is scheduled for April 9 – 10, 2024, at the Penn Stater Hotel and Conference Center in State College. The event will convene criminal justice, behavioral health, and treatment partners for a dynamic one and a half-day gathering. Featuring a lineup of national and local experts, discussions will center on emerging issues impacting criminal justice and behavioral health systems, offering innovative strategies and collaborative solutions.

Registration and conference details are available on the 2024 CJAB Conference page on PCCD’s website. Additionally, notable sessions include a plenary by Jason Snyder, RCPA SUD Policy Director, on April 9, and a workshop on SUD confidentiality facilitated by RCPA, which will include representatives from the SUD treatment and criminal justice systems on April 10. Attendees should be aware that the discounted room rate deadline is Friday, March 8, 2024.

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The Pennsylvania Department of Human Services (DHS) is hosting a post-award forum regarding the federal Section 1115 Demonstration, which includes Medicaid coverage for out-of-state former foster care youth and substance use disorder (SUD) services. It will take place at 1:00 pm – 2:30 pm on Friday, March 8, 2024, via WebEx. The forum aims to gather public feedback on the progress of these initiatives, both of which were approved by the Centers for Medicare & Medicaid Services (CMS). The Former Foster Care Youth (FFCY) component allows Medicaid coverage for individuals under 26 who were in foster care in another state upon turning 18. The SUD component provides funding for essential SUD services, including residential care.

Register for the forum here. Written comments are also acceptable until the same date. For inquiries, contact Shivani Patel. Further details and the announcement can be found here. Please contact RCPA Policy Director Jim Sharp for any further questions.

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During this week’s budget presentation by Governor Shapiro, funding for mental health services was addressed as a priority for vulnerable Pennsylvanians. RCPA is working to review the preliminary funding recommendations listed below, and we hope to have greater line-item insight from DHS Secretary Arkoosh’s address this Friday.

Please note that registration is now open for the DHS 2024/25 Budget Briefing. You can register to view the briefing here. Additionally, the DHS House and Senate Budget Hearings will be March 5 and 6, 2024, respectively, and RCPA has been asked to provide questions for the testimony. The DHS budget book is available here.

Lastly, as part of our RCPA Mental Health Steering Committees and Work Groups, we will review recommendations as we develop our strategic budget advocacy campaign over the next several months in our meetings with stakeholders and legislators.

We offer the following as the initial review of yesterday’s budget presentation:

2024/25 Budget: Mental Health Program Recommendations:
This budget recommends the following changes: (Dollar Amounts in Thousands) for Mental Health Services

  • $20,000 — To replace nonrecurring prior-year carryover funding.
  • $5,750 — Initiative to expand diversion and discharge for individuals with mental illness currently in the criminal justice system.
  • $18,259 — To continue current programs.
  • $20,000 — To restore one-third of base funding to counties.
  • $3,443 — To replace federal funding received in 2023/24.
  • $5,000 — Initiative to maintain walk-in mental health crisis for COVID-19 response stabilization centers serving multiple counties.
  • $1,250 — To annualize prior-year expansion of home and community-based services.
  • $1,600 — Initiative to provide home and community-based services for 20 individuals currently residing in state hospitals.
  • $305 — To annualize prior-year expansion of diversion state hospitals and discharge programs.
  • $10,000 — Initiative to provide support to the 988 network for mental health services.
  • $85,607 — To increase appropriations.

School-Based Mental Health
This year, the Shapiro Administration looks once more to address the needs of student mental health with a $100 million investment. This new set of funds comes on the heels of $90 million recently allocated to schools, with monies originally set aside for adult mental health services targeted through the now defunct 2022 Behavioral Health Commission.

The funding mechanism for the distribution of these funds has yet to be determined if it is approved by the General Assembly. The last two rounds of school-based mental health funding have been allocated to individual districts through noncompetitive grants. The concerns have been that the funds, if not earmarked for the development of service delivery pathways, will go to building staff infrastructure in the form of social workers. While there are advantages to having these professionals in the buildings, they alone cannot address the student needs for assessment and treatment services

RCPA supports the funding being designated through the schools but will work with legislators to encourage developing a coordinated system of care coupled with a longer-term financial strategy with the schools, community-based providers, Student Assistant Programs (SAP), and county involvement in SAP coordination.

Early Intervention Services
As part of our initial budget discussions with OCDEL, we were concerned that there would not be an interim rate increase for 2024/25 as we work through the new Early Intervention rate methodology. We see in the budget that there is an increase of $16 million, nearly 9% over last year’s number. It is also projected that more children and families will be served in this coming year, and we will work with the administration to, at a minimum, continue to fund the ARPA-supported 3% increase from over the last three years.

County Child Welfare
It is projected that the County Child Welfare budget will essentially be flat, with less than a 1% increase. As the child welfare systems await the DHS Blueprint recommendations on addressing the extensive number of services for youth with complex care, especially those in congregate care, it was surprising there was not a designated funding allocation to support this initiative. This remains a priority to fund these programs.

County-Based Mental Health Funding
It was disappointing that the Shapiro Administration failed to deliver on last year’s “down payment” of the 2022/23 allocation of $20 million towards the county base. Up until last year, the county-based mental health system has gone more than a decade without a base rate increase. Last year’s $20 million represented only a 3% increase over the 2022/23 base funding. This year’s $20 million will equate to less.

We will continue, as part of our advocacy strategy, to support an allocation that is projected to be in the neighborhood of $1.2 billion to create a sustainable platform for county-based mental health service delivery.

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