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Substance Use Disorder

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On behalf of its opioid treatment program (OTP) provider members, RCPA submitted comments to the Independent Regulatory Review Commission (IRRC) in support of a final-omitted regulation that would allow an initial physical examination required for prescribing, administering, and dispensing controlled substances through an OTP to be conducted via telehealth under certain circumstances under Pa. 49 Code § 16.92.

This final-omitted regulation would enable the Pennsylvania Department of Drug and Alcohol Programs (DDAP) to grant a statewide exception to 28 Pa. Code § 715.9(a)(4), which today requires Pennsylvania OTPs (called narcotic treatment programs in DDAP regulations) to conduct a face-to-face determination of whether an individual is currently physiologically dependent on an opioid.

IRRC will consider the final-omitted regulation at a public meeting on December 5.

In its comments, RCPA wrote:

“Enabling OTPs to conduct the initial examination required as part of induction into methadone or buprenorphine treatment through telehealth significantly improves and expedites patient access to the gold standard treatment for OUD without sacrificing quality or safety. In a treatment environment where finding qualified physicians, physician assistants and certified registered nurse practitioners is challenging, telehealth bridges a significant gap. Physicians would no longer need to be physically on site at the OTP where treatment is to take place to examine a patient as part of the induction process. Rather, from anywhere in the commonwealth, a physician can examine more patients, who can then begin treatment with medication faster at a facility near their home. In fact, with this final-omitted regulation, OTPs will have the ability to accommodate same-day or walk-in admissions instead of scheduling intake appointments days later.”

The final-omitted regulation, submitted by the Department of State, Bureau of Professional and Occupational Affairs, State Board of Medicine, along with comments in support from the Department of Drug and Alcohol Programs and RCPA, can be viewed on the IRRC website.

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The PA Department of Labor & Industry’s Office of Vocational Rehabilitation (OVR) has further developed the draft of the Financial Needs Test (FNT) policy after incorporating feedback received during the September 2024 public comment period. As a result, there will be a second, shorter public comment period on the draft. The draft will be posted on OVR’s website for public review beginning November 11, 2024.

Virtual meetings will be held via Zoom at 9:00 am and 2:30 pm on Monday, November 18, 2024, to provide an overview of the policy and accept comments (content will be the same in both meetings). The public is invited to comment on the draft policy through November 22, 2024. Comments may be directed to OVR’s Public Comment inbox.

Zoom Meeting Information:

CART and sign language interpreters will be available for these meetings via the Zoom link.

Additional auxiliary aids and services are available upon request to individuals with disabilities. Please send your request to OVR’s Public Comment inbox.

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Image by DarkmoonArt_de from Pixabay

The Office of Mental Health and Substance Abuse Services (OMHSAS) has announced the 2025 quarterly meeting dates for next year’s OMHSAS Stakeholder Webinars and asks that you mark your calendars.

2025 OMHSAS STAKEHOLDER WEBINAR DATES:

  • January 30, 2025 — 3:00 pm – 4:00 pm
  • April 24, 2025 — 3:00 pm – 4:00 pm
  • July 17, 2025 — 3:00 pm – 4:00 pm
  • October 23, 2025 — 3:00 pm – 4:00 pm

In the meantime, if you have suggestions for agenda topics for January’s webinar, please submit them via email. We will monitor the account and will only reply to the sender if more information is needed. Responses will not be provided if additional information is not needed.

Please note that webinar links will be provided closer to each of the meeting dates as shown above.

Thank you for your review and please – SAVE THE DATE.

If members have any questions, please contact RCPA COO and Mental Health Director Jim Sharp.

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Northern Tier Counseling Inc. held the ribbon cutting of their Drug and Alcohol Wellness Treatment Center, dedicated to State Representative Tina Pickett, on Friday, May 24.

NTC, Inc. President Paul DeNault explained that this grand opening is thanks to not only the staff at NTC, Inc., but also the All One Foundation, who granted NTC, Inc. the All In One Grant to help the idea come to life as well as Tina Pickett, whose legislation allows for the progression of drug and alcohol treatment.

View the full press release here.

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Living the D.R.E.A.M! Creating a Culture of Health and Wellness for All
December 4, 2024
9:00 am – 12:00 pm

The Department of Human Services’ (DHS) Office of Developmental Programs (ODP) and the Office of Mental Health and Substance Abuse Services (OMHSAS) have announced the Dual Diagnosis Professional Conference “Living the D.R.E.A.M.” During this session, SPIN will provide an historical overview of how they created a culture of health and wellness by engaging all stakeholders in living a healthy lifestyle. Presenters will showcase SPIN’s mission of inclusive and holistic meaningful activities in the community and SPIN Community & Fitness, a gathering and welcoming place for the whole community. The D.R.E.A.M team model, including the vision and purpose, elements of “Living the D.R.E.A.M,” and lessons learned for successful incorporation into everyday lives, will be featured.

Registration is now open.

See the announcement for a full session description, presenter biographies, and how to register.

Email with any questions.

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Image by Markus Winkler from Pixabay

Message from the Office of Long-Term Living (OLTL):

The Commonwealth is working collaboratively — Governor Shapiro’s office and the health hub agencies (Health, Human Services, Drug and Alcohol Programs, and Insurance) — to develop a statewide maternal health strategic plan. We need your help to make it a robust, comprehensive, collaborative, living, and most importantly, active plan.

As you are likely aware, Pennsylvania, like the nation, is experiencing a maternal health crisis.

According to the Pennsylvania Maternal Mortality Review Committee report, in 2020, Pennsylvania residents experienced a pregnancy-associated mortality ratio of 83 deaths per 100,000 live births with large disparities identified. In total, 107 individuals lost their lives during pregnancy, delivery, or up to one year postpartum.

Those numbers are far worse for Black women, where the rate was twice as high at 163 deaths per 100,000.

We also know that women and birthing people with disabilities experience unique challenges and needs on their health journey, so we are inviting you to join us for a 90-minute Zoom listening session where members of the Commonwealth’s health agencies and members of the statewide maternal health strategic plan can engage with you to learn what specific needs you have and how you feel the Commonwealth should address those needs.

We want our strategic plan to address all Pennsylvania women and birthing people, and sharing your voice at this listening session will help inform our plan.

The Zoom listening session is scheduled from 10:00 am – 11:30 am, on Friday, December 6, 2024. Please RSVP electronically by December 1 if you plan to attend. We will send the Zoom link by end of day December 4 to those who RSVP.

Thank you for considering spending 90 minutes with the disability community and state health team members to share your thoughts and needs around maternal health.

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On Friday, November 1, the Centers for Medicare & Medicaid Services (CMS) released an anticipated Final Rule titled “CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC),” which includes three new exceptions for the federal “four walls” rule. At present, the “four walls” rule prohibits Medicaid payment for clinic services when both the practitioner and individual receiving service are outside of the “four walls” of the clinic unless the services are being provided to unhoused individuals (such as through street medicine). The new exception for Indian Health Services and Tribal Facilities is required nationally. The exceptions for Behavioral Health Clinics and Rural clinics are optional. States who determine that their Behavioral Health Clinic and/or Rural Health Clinic populations served meet the four criteria established by CMS (see page 1323 of the final rule) must submit a Medicaid State Plan Amendment (SPA) and receive approval from CMS for these exceptions to be in place for their state.

The Office of Mental Health and Substance Abuse Services (OMHSAS) had been working toward a short-term state level solution to the four walls issue for both Outpatient Psychiatric Clinics and Drug and Alcohol Clinics. However, now that a long-term federal option has been made available, the team in OMHSAS will be pivoting to pursue this newly available federal exception for Behavioral Health Clinics. While OMHSAS is still in the process of developing a timeline for the new State Plan Amendment, their team will be working on this as a top priority, with the goal of having a SPA in place in early 2025.

It has been confirmed that OMHSAS will not be shifting their current enforcement policy around the four walls while they work through getting this waiver in place. RCPA will continue its collaboration with OMHSAS on the process as this move forwards. If you have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.

For additional information, please see the following:

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Mark your calendars and plan to join IPRC for our exciting 2025 educational webinar series! Complimentary registration for all IPRC webinars is a benefit of your RCPA/IPRC Membership.

Thursday, January 16, 1:00 pm – 2:00 pm EST 
Neuro-Opthalmic Rehabilitation

Friday, February 7, 1:00 pm – 2:00 pm EST
POTS (Postural Orthostatic Tachycardia Syndrome)

Monday, March 3, 12:00 pm – 1:00 pm EST
Data-Driven Decision Making

Monday, March 24, 12:00 pm – 1:00 pm EST
Evidence-Based Practice: A Clinical Perspective

Tuesday, April 15, 11:00 am – 12:00 pm EDT
Part 1: Motivational Interviewing with Children

Tuesday, April 22, 11:00 am – 12:00 pm EDT
Part 2: Additional Strategies for Patient Engagement

Tuesday, May 20, 1:00 pm – 2:00 pm EDT
Treating FND: Functional Neurologic Disorder

Thursday, September 4, 12:00 pm – 1:00 pm EDT
The Therapy Intensive Model

Tuesday, October 7, 11:00 am – 12:00 pm EDT
Treating Non-Accidental Trauma

Monday, November 3, 12:00 pm – 1:00 pm EST
The Intersect of Functional Imaging and Clinical Presentations

Monday, December 8, 2:00 pm – 3:00 pm EST
Treating Pediatric Burns

Do you have a great topic or know a fantastic presenter? Please reach out to Cindi Hobbes, IPRC Director.

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Removes Barriers to Delivering Telehealth Outside the Clinics

On Friday, November 1, the US Centers for Medicare and Medicaid Services (CMS) released a final rule for calendar year 2025 that will give states the option to cover Medicaid telehealth behavioral health clinic services delivered outside the “four walls.” Previously, under 42 CFR § 440.90, the “Four Walls Rule,” it was required that during Medicaid outpatient behavioral health clinic telehealth services, either the patient or the clinician had to be physically onsite at the clinic.

CMS waived this requirement during the Public Health Emergency (PHE). Now that the PHE has ended, CMS has released this final rule to allow states to cover behavioral health outpatient clinic services outside the four walls. The final rule should take effect on January 1, 2025. In the meantime, it is the expectation that telehealth services will continue to be delivered as per current operating standards to ensure service access to individuals.

CMS amended the Medicaid clinic services’ regulation to authorize Medicaid coverage for clinic services furnished by IHS/Tribal clinics outside the “four walls” of their facility. In addition, states implementing the Medicaid clinic services’ benefit can opt to cover clinic services furnished outside the “four walls” of behavioral health clinics or clinics located in rural areas. For clinics located in rural areas, based on comments received, CMS is finalizing an approach to defining “rural area” where states will select either a definition used by a federal agency for programmatic purposes, or a definition adopted by a state agency with a role in setting state rural health policy.

For more information, view the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule (CMS 1809-FC) Fact Sheet and the full Final Rule.

RCPA will be reviewing the implications of this final form ruling for Pennsylvania and our ongoing efforts to expand telehealth services through legislative action. RCPA offers thanks to our members, as well as DHS/OMHSAS, County Primary Contractors, BH-MCOs, the National Council on Mental Wellbeing, and our stakeholder groups and associations for their collaborative advocacy to remove the “4 Walls” barriers to equity and access through telehealth.

If you have any additional questions, please contact RCPA COO and Mental Health Division Director Jim Sharp.

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