Following the Commonwealth Court’s decision to deny the Drug and Alcohol Service Providers Organization of Pennsylvania’s (DASPOP) request for a preliminary injunction against key pieces of the ASAM transition, the Department of Drug and Alcohol Programs (DDAP) participated in RCPA’s Drug and Alcohol Committee meeting on Tuesday, Dec. 14. You can read the court’s opinion here.

Despite establishing a deadline by which providers must align with the ASAM Criteria, including the “PA-Specific Alignment Requirements,” and in particular referencing the changes in IOP ratio, daily therapeutic hours, and credentialing as “PA-Specific Alignment Requirements” of the ASAM transition on its website, DDAP argued in court that these are “guidelines,” not requirements. The challenge for providers, however, is that the single county authorities (SCAs) and behavioral health managed care organizations (BHMCOs) have signaled all along that they will require providers to comply with these pieces of the ASAM transition through contracts. Now, DDAP’s pivot to calling them “guidelines” has created confusion among providers and payers. RCPA has contacted each of the five BHMCOs and the Pennsylvania Association of County Drug and Alcohol Administrators (PACDAA) to ask whether DDAP’s testimony and the court’s decision will change their approach to enforcing the guidelines/mandates in question through their contracts. We will pass along any relevant information we may receive. In addition, DDAP told us it will be issuing guidance and clarification on these guidelines right before or after the new year.

At RCPA’s D&A Committee meeting last week, DDAP Deputy Secretary Ellen DiDomenico explained how ASAM explicitly defines its criteria versus DDAP’s interpretation of that criteria and what it is now calling recommended guidelines. For example, while the ASAM Criteria explicitly calls for daily clinical hours, DDAP has established six to eight daily therapeutic hours as the application of ASAM’s criteria in Pennsylvania. As DDAP has communicated all along, Deputy Secretary DiDomenico explained that if providers can demonstrate the ability to provide individualized care in ways other than what DDAP “recommends,” it will consider those.

DDAP also said at the meeting that nothing has changed with the court’s decision, which we would interpret to mean that unless a provider has been approved to provide care in a way other than what DDAP recommends, providers must be aligned with their guidelines by Jan. 1, 2022. For example, unless a provider has been approved to provide intensive outpatient services at a ratio other than 1:15, that provider must meet the 1:15 guideline. DDAP also said at the meeting that it is working with the MCOs and SCAs to develop a monitoring tool with the goal being development of a collaborative monitoring process so that providers will not need to be monitored for ASAM alignment by multiple payers. Deputy Secretary DiDomenico also said that monitoring of ASAM compliance would focus on ASAM Criteria as explicitly written in the ASAM Criteria 3^rd Edition.

Lastly, House Bill 1995, which would have forced DDAP to go through the regulatory review process any time it made changes that affect licensed addiction treatment providers, has stalled in the Senate. After sailing out of the House of Representatives on a timeline that would have enabled it to pass the Senate and land on the governor’s desk before Jan. 1, the Senate Health and Human Services Committee did not take up the bill for vote. With the General Assembly recessed through the end of the year, there is no possibility of HB 1995 providing relief to providers on the confusion around these ASAM guidelines before Jan. 1.

Given the contradictions and confusion, we will share any guidance we get from DDAP as soon as we get it. Please contact RCPA Drug and Alcohol Division Director Jason Snyder with any questions.