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Substance Use Disorder

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Effective January 1, Act 111 of 2022 amended the Controlled Substance, Drug, Device, and Cosmetic Act of 1972 to no longer define fentanyl test strips (FTS) as drug paraphernalia in Pennsylvania, making them a legal, low-cost method to prevent drug overdoses.

The Pennsylvania Departments of Drug and Alcohol Programs, Health, and Human Services, and the Pennsylvania Commission on Crime and Delinquency have created a survey to gauge interest in and demand for FTS as the administration works to make them available at no cost across the commonwealth. The survey contains questions on currently available trainings/materials, preferred brands, and current distribution methods and takes about five minutes to complete.

Organizations are urged to complete the survey here and to distribute the link to others.

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House Republican Appropriations Chairman Seth Grove will lead a roundtable discussion with Medicaid (MA) Managed Care Organizations (MCOs) on February 7, 2023, at 10:00 am.

Committee Chairman Grove will be joined by House members and the following testifiers:

  • Emily Katz, Executive Director of PAMCO;
  • Joanne McFall, Market President of Keystone First;
  • Matthew Hurford, President/CEO of Community Care Behavioral Health;
  • James Schuster, Chief Medical Officer of UPMC Insurance Services Division;
  • Jack Carroll, Executive Director of Cumberland-Perry Drug & Alcohol Commission;
  • John Koehn, Market President of Community HealthChoices, AmeriHealth Caritas;
  • Justin Davis, Plan President/CEO of PA Health & Wellness; and
  • Brendan Harris, Vice President of Community HealthChoices, UPMC Health Plan.

The hearing will be held in Room 60 East Wing, Main Capitol, State Capitol Complex in Harrisburg. The hearing will also be streamed live.

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Hole torn in a dollar bill with medicaid text

Because of the continuous coverage requirement, states were able to use additional money from the federal government during the federal public health emergency (PHE) for health care programs like Medicaid if they kept people covered. Therefore, Pennsylvanians did not lose their Medicaid/Medical Assistance (MA) or CHIP coverage if their income changed or they did not complete a renewal during the PHE.

However, starting April 1, 2023, Pennsylvania and other states will have to start disenrolling people if households are ineligible for MA at the time of their renewal or do not complete their renewal. The Pennsylvania Department of Human Services (DHS) will have to return to normal renewal processing procedures for Pennsylvanians enrolled in MA and the CHIP. Renewals will be completed over 12 months. Everyone with MA or CHIP coverage will need to submit a renewal to see if they are still eligible.

In Pennsylvania, approximately 3.5 million people rely on Medicaid. Last year, it was estimated that about 500,000 of those would lose coverage when the continuous coverage requirement ended, creating access issues for individuals and exacerbating financial challenges for providers.

The Pennsylvania Department of Human Services has created an online resource, including a stakeholder toolkit as well as a guide on how to become a helper, that provides resources for groups like providers to communicate ways for Pennsylvanians who receive MA or CHIP coverage to continue their coverage.

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Greenspace Health has their next educational panel in the calendar, focused on a topic relevant to all of you — the value of therapeutic alliance. Dr. Brent Mallinckrodt, co-author of the 18-item “Brief Revised Working Alliance Inventory” (BR-WAI), will share the importance of the client-clinician relationship, the three vital components of a strong therapeutic alliance, and how to best use the BR-WAI in practice. To round out the conversation will be Emily Miller, a Master’s Level Psychotherapist and National Clinical Counselor from Pinebrook Family Answers in Pennsylvania, speaking on her experience of using the BR-WAI in practice and the impact it’s had on her clients’ outcomes.

You won’t want to miss this opportunity to learn more about one of the most important predictors of positive symptom change for people in care: the working alliance.

Register here: How To Measure and Improve Therapeutic Alliance — February 23 at 1:00 pm EST.

Watch this short video for highlights from the last educational panel hosted by Greenspace Health, featuring the Yale Measurement-Based Care Collaborative!

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On January 30, the Biden Administration announced that the COVID-19 national emergency and public health emergency (PHE) will both expire on Thursday, May 11, 2023. Under Act 30 of 2022, the Department of Drug and Alcohol Programs’ (DDAP) regulatory suspensions that are “related to federal exemptions granted under the federal public health emergency declaration” were extended until “the last day federal exemptions granted under the federal public health emergency declaration are authorized.” In other words, Act 30 aligned the timing for DDAP’s regulatory suspensions with the deadline for flexibilities granted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) — not with the deadline of the PHE itself.

Below is a description of each currently suspended regulation and what DDAP knows about efforts to make these changes permanent at the federal level.

Methadone Take-Home Supply

Current regulatory suspension: Under the federal PHE, SAMHSA is currently allowing up to 28 days of take-home medications for patients on stable dosages, as deemed appropriate by their physician. DDAP’s regulation 28 Pa. Code § 715.16(e) (prohibiting narcotic treatment programs [NTPs] from permitting a patient to receive more than a two-week take-home supply) is currently suspended under Act 30.

Expiration of the PHE: In November 2021, SAMHSA announced that the methadone take-home flexibilities will be extended for one year after the end of the PHE (now May 11, 2024). DDAP submitted its written concurrence with this exemption in February 2022. Furthermore, SAMHSA issued a notice of proposed rulemaking in December 2022 that proposes modifying regulations related to methadone take-home supply up to 28 days, among other changes.

Buprenorphine Telehealth

Current regulatory suspension: Under the federal PHE, SAMHSA and the DEA are currently allowing initial evaluations for a patient who will be treated with buprenorphine to be completed via telehealth. DDAP has two related regulations that are currently suspended under Act 30:

  • 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 medication to treat opioid use disorder (OUD).
  • 28 Pa. Code § 715.6(d): Requires NTPs to have narcotic treatment physician services onsite.

Expiration of the PHE: In March 2022, the DEA announced that it is currently working to make its teleprescribing regulations permanent. In June 2022, SAMHSA announced to State Opioid Treatment Authorities that flexibilities around telehealth evaluations before buprenorphine treatment at NTPs, specifically, will be extended for one year after the end of the PHE (now May 11, 2024).

SAMHSA and DEA have made clear that support for these flexibilities has been overwhelmingly positive, decreased stigma associated with OUD, and enhanced care for patients. Given the information above, DDAP does not anticipate any lapses in these flexibilities at either the federal or state level but will continue to provide updates and guidance as available.

Resources

If you have any further questions, please contact the Bureau of Program Licensure at (717) 783-8675 or via email.

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As discussed in the recent RCPA Telehealth Operations Work Group meeting, the Office of Mental Health and Substance Abuse Services (OMHSAS) announced a telehealth funding opportunity. To participate in this funding, or for additional details, please visit this website.

OMHSAS will accept funding requests beginning today, February 1, 2023. RCPA recommends all members interested in this funding to review the announcement as soon as possible.

If you have questions or concerns related to this opportunity, please send via email. If you have any other questions, please contact RCPA Policy Director Jim Sharp.

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