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Substance Use Disorder

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) is awarding $9 million to single county authorities (SCAs) to establish or expand crisis stabilization services for individuals who present with substance use disorder (SUD) and co-occurring mental health symptoms. Such services include assessment and stabilization of acute physical and psychiatric symptoms, which may include medical management and behavioral interventions, induction on medication-assisted treatment, level of care assessments, short-term stays, and connections to supportive services.

Grants of up to $3 million will be awarded to eligible SCAs and can be applied toward a range of activities, including construction and building infrastructure, staffing, and programming. The SCAs may provide or coordinate the services.

SUD crisis stabilization services must have the capacity to recognize and manage individuals presenting with a wide range of SUD-related symptoms, mental health disorders, and developmental disabilities. Funds can be applied toward a range of activities, including construction and building infrastructure, staffing, and evidence-based programming.

Earlier this year, the General Assembly allocated its 2022 $17 million portion of Pennsylvania’s $1.07 billion opioid settlement to DDAP. The overall settlement was reached between states’ attorneys general and Johnson & Johnson, AmerisourceBergen, Cardinal Health, and McKesson.

DDAP plans to use the remaining money from this year’s opioid settlement allocation to provide treatment and recovery support services to communities of color; address workforce issues; and fund services in the Kensington area of Philadelphia with a $1 million grant. Read more about the crisis services grants.

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The Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2023 Medicare Physician Fee Schedule (MPFS) in the Federal Register for November 18, 2022. Some of the key provisions contained in the final rule include (and are effective on January 1, 2023):

Medicare Telehealth Services

  • Addition of new HCPCS codes to the list of Medicare telehealth services on a Category 1 basis.
  • Implementation of the 151-day extensions of Medicare telehealth flexibilities, including allowing telehealth services to be provided in any geographic area and in any originating site setting.
  • Permission for physical therapists, occupational therapists, speech-language pathologists, and audiologists to provide telehealth services.
  • Listing of codes added to the telehealth services list are here.

Evaluation & Management (E&M) Visits

  • For CY 2023, CMS finalized changes for “Other E/M” visits that parallel the changes that were made in recent years for office/outpatient E/M visit coding and payment. Other E/M visits include hospital inpatient, hospital observation, emergency department, nursing facility, home services, residence services, and cognitive impairment assessment visits.

Behavioral Health

  • Proposal finalized to create a new HCPCS code (G0323) describing General Behavioral Health Integration performed by clinical psychologists or clinical social workers to account for monthly care integration where the mental health services provided are serving as the focal point of care integration.

Chronic Pain Management

  • Finalized a CY 2023 proposal to create two new G codes (G3002 and G3003) performed by physicians and other qualified health professionals describing monthly CPM for payment starting January 1, 2023.

Opioid Treatment Programs (OTPs)

  • CMS finalized the proposal to allow the OTP intake add-on code provided via 2-way, interactive, audio-video technology when billing for the initiation of treatment with buprenorphine using audio-video technology to start treatment with buprenorphine as authorized by the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) at the time the service is provided.
  • CMS also finalized the proposal to permit the use of 2-way, interactive, audio-only technology to start treatment with buprenorphine in cases where audio-video technology isn’t available to the patient and all other applicable requirements are met.

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The Department of Health and Human Services (HHS) released a new report that highlights patients’ experience of Long COVID to better understand its complexities and drive creative responses by government leaders, clinicians, patient advocates, and others. The Health+ Long COVID Report builds on President Biden’s Memorandum on Addressing the Long-Term Effects of COVID-⁠19 and the two previously issued HHS Long COVID reports. The report was commissioned by HHS and produced by Coforma, an independent third-party design and research agency. It provides recommendations on how to deliver high-quality care and relevant and intentional resources and supports to individuals and families impacted by Long COVID.

Last week, the Administration sent a $750 million dollar supplemental funding request to Congress to support Long COVID research and treatment. This funding request would support HHS and their continued work on Long COVID, providers who serve patients with Long COVID and its associated conditions, and community-based organizations that assist with case management and provide other essential services and supports.

The report offers a variety of short-term and longer-term recommendations that come directly from the patient experience.

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