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DDAP

With Senate Bill 1019 passed into law as Act 14, the Department of Drug and Alcohol’s (DDAP) regulatory suspensions are also extended. These regulatory suspensions are “related to federal exemptions granted under the federal public health emergency declaration” until “the last day federal exemptions granted under the federal public health emergency declaration are authorized.” In addition to three DDAP regulatory suspensions, one additional regulation from the Department of State, also relevant to the field, is included in the chart below and also remains suspended.

Statute/Regulation Statute/Regulation Purpose

Waiver Benefit/Explanation

28 Pa. Code § 715.16(e)

Prohibits narcotic treatment programs (NTPs — methadone clinics) from permitting a patient to receive more than a 2-week take-home supply of medication In response to COVID-19, SAMHSA is allowing up to 28 days of take-home medications for patients on stable dosages, if the physician deems appropriate.
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 buprenorphine treatment. In response to COVID-19, SAMHSA is allowing initial evaluations for a patient who will be treated with buprenorphine to be completed via telehealth.
28 Pa. Code § 715.6(d) Requires NTPs to have narcotic treatment physician services onsite. In response to COVID-19, SAMHSA is allowing initial evaluations for a patient who will be treated with buprenorphine to be completed via telehealth.
49 Pa. Code § 16.92(b)(1)

(Department of State)

Before a patient can be prescribed any controlled substance in Pennsylvania, a person licensed to practice medicine and surgery in the commonwealth, or otherwise licensed or regulated by the State Board of Medicine, must take an initial medical history and conduct an initial physical examination, unless emergency circumstances justify otherwise.

In response to COVID-19, the Department of State suspended the initial medical history and physical examination requirement specifically for the treatment of opioid-use disorder with buprenorphine.

 

In November 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that the methadone take-home flexibilities will be extended for one year after the eventual expiration of the federal COVID-19 Public Health Emergency. DDAP has submitted its written concurrence with this exemption. SAMHSA has also indicated that they are currently considering mechanisms to make this flexibility permanent. Narcotic treatment programs do not need to do anything additional at this time to continue taking advantage of this flexibility.

Similarly, the U.S. Drug Enforcement Administration (DEA) also announced last week that they are currently working to make their teleprescribing regulations permanent. DDAP will continue to provide additional information and guidance as it becomes available.

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

With this week’s signing of the federal Consolidated Appropriations Act of 2022, the Pennsylvania Department of Drug and Alcohol Programs (DDAP) expects its budget for Fiscal Year (FY) 2023 to be at least equal to the current year’s budget of $378 million. Before the signing of the act, DDAP’s budget was $317 million. The difference was the result of a $60 million gap in a state opioid response (SOR) grant that has been restored. The majority of DDAP’s funding comes from the federal government, as opposed to state dollars.

As part of the Federal Appropriations Act, $3.9 billion has been budgeted for substance use treatment, including continued funding for opioid prevention and treatment, recovery, and tribal focused treatment efforts. This includes $1.85 billion for the Substance Abuse Prevention and Treatment Block Grant (SABG); $1.525 billion for SOR Grants; $34.9 million for Pregnant & Postpartum Women; $13 million for Building Communities of Recovery; and $101 million for Medication Assisted Treatment.

In its Senate Appropriations Hearing yesterday, DDAP said that, although the exact amount of Pennsylvania’s SOR grant for FY 2023 was not yet know, it expected it to be at least as much as the current year’s grant, which is $178 million.

The Senate Appropriations Committee will meet for a budget hearing with the Department of Drug and Alcohol Programs (DDAP) at 2:30 pm today, March 16. The budget hearing will be livestreamed. Please note that RCPA provider members received an email from RCPA earlier this week that incorrectly stated the hearing was at 10:00 am today.

For Fiscal Year 2022/2023, the governor is budgeting a total of $317 million for DDAP, which is a 16 percent reduction over the current fiscal year’s budget of $379 million. The decrease is due to a $60 million reduction in federal State Opioid Response dollars.

More details of DDAP’s budget are available in DDAP’s Bluebook. In addition, a previous communication from RCPA about DDAP’s budget ahead of its House Appropriations Committee provides additional detail about the $317 million budget.

The House Appropriations Committee will meet for a budget hearing with the Department of Drug and Alcohol Programs (DDAP) at 10:00 am on Thursday, March 3. The budget hearing will be livestreamed.

For Fiscal Year 2022/23, the governor is budgeting a total of $317 million for DDAP, which is a 16 percent reduction over the current fiscal year’s budget of $379 million. The decrease is due to a $60 million reduction in federal State Opioid Response dollars.

Of the total amount budgeted from the General Fund for the upcoming fiscal year, $270 million is budgeted for grants and subsidies to drug and alcohol programs. Of those funds, 75 percent ($220 million) comes from federal grants, including:

  • SAMHSA’s Substance Abuse Prevention and Treatment Block Grant (SABG) ($80 million);
  • State Opioid Response (SOR) Grant ($118 million); and
  • Substance Abuse Special Projects Grants ($22 million).

The remaining $50 million earmarked for drug and alcohol programs in the General Fund come from the McKinsey opioid settlement ($5 million) and $45 million in state funding.

Other funds in DDAP’s budget include the Compulsive and Problem Gambling Treatment Fund ($13 million), the Medical Marijuana Program Fund ($6 million), and the State Stores Fund ($5 million).

DDAP’s budget also includes $23 million ($3 million of which is state money) earmarked for operation and administration of the department and its various grant programs. The federal grants allow for a percentage of the funds to be used for operations and administration. Operations and administration also includes the department’s complement, or staffing, and their salaries.

While most of the SABG and state funding earmarked for drug and alcohol programs are distributed through the Single County Authorities, SOR and other special grant projects are delivered typically through a grant process. Details of initiatives that these grants have funded can be found on DDAP’s Department Funding web page.

As the regulator of the state’s addiction treatment system, DDAP’s funding of drug and alcohol programs pales in comparison to the Department of Human Services’ budget for drug and alcohol services. The governor has budgeted $6 billion for behavioral health services for Medicaid capitation rates, $1.6 billion of which is earmarked for drug and alcohol.

More details of DDAP’s budget are available in DDAP’s Bluebook.

DDAP’s Senate Appropriations Hearing is set for 2:30 pm, Wednesday, March 16.

Act 126 of 2020 amended the original 2012 Methadone Death and Incident Review (MDAIR) Act, which established the creation of a team to review methadone-related deaths or incidents, to go beyond methadone and include a review of death and incidents related to any Food and Drug Administration (FDA)-approved medication to treat opioid use disorder as a primary, secondary, or contributing factor to a death or incident.

As a result of the new law, the Pennsylvania Department of Drug and Alcohol Programs selected a new MDAIR team to review medication-related deaths, communicate concerns, and develop best practices to prevent future medication-related deaths and incidents.

A list of the new team members can be found here.

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) announced more than $15 million in grant funding for stabilization payments to substance use disorder (SUD) treatment providers to assist with pandemic-related expenses.

Through 108 grant agreements, 375 SUD treatment provider locations will receive funding. Grantees span across every Pennsylvania county, and all eligible applicants who applied were awarded funding. A list of grantees and awards are available on the DDAP website. However, funding amounts will not be finalized until all grant agreements are fully executed. This funding will aid in pandemic-related expenses, including but not limited to minimizing the spread of COVID-19 by ensuring the provision of testing and support of vaccines as appropriate and delivering quality, evidence-based treatment to individuals who are underinsured or uninsured.

The grants are part of $55 million in federal funding awarded to Pennsylvania through the Substance Abuse and Mental Health Services Administration (SAMHSA) Substance Abuse Prevention and Treatment Block Grant Program COVID-19 Supplemental Awards.

DDAP Modifies ASAM Transition Web Page, Archives Addendums That Outlined IOP Ratio and Daily Therapeutic Hour “Expectations”

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) has overhauled its ASAM Transition web page, removing previous references to “expectations for contractual compliance” in areas of ASAM Criteria where DDAP originally went beyond the Criteria as explicitly written. Newly revised information, including an updated “Guidance for the Application of The American Society of Addiction Medicine, 3rd Edition, 2013 in the Pennsylvania Substance Use Disorder Treatment System for Adults” and “ASAM Frequently Asked Questions” document, references the 1:15 intensive outpatient (IOP) counselor-to-patient ratio and the six to eight daily therapeutic hours at residential level of care as a DDAP “recommendation.”

The change is significant because, according to the Pennsylvania Department of Human Services (DHS) Office of Mental Health and Substance Abuses Services (OMHSAS), per its HealthChoices Behavioral Health Program Standards and Requirements for Primary Contractors document, “the Primary Contractor and its BHMCO must ensure that the SUD providers in the network comply with program standards in the ASAM Criteria, included but not limited to admission criteria, discharge criteria, interventions/types of services, hours of clinical care, and credentials of staff as set forth in the ASAM transition requirements found at https://www.ddap.pa.gov/Professionals/Pages/ASAM-Transition.aspx.” In other words, providers were expected to be in compliance with any information published as an expectation on that page.

For months following DDAP’s testimony in Commonwealth Court that the IOP and daily therapeutic overreaches were simply “guidelines,” the provider community remained unclear on whether they would be required to comply with the “guidelines” as part of their contracts with the BHMCOs. Still, providers have not yet seen the evaluation tool that will be used to audit their compliance with ASAM Criteria despite DDAP’s expectation that they be “substantially aligned” with those Criteria by Jan. 1, 2022.

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) is now offering “Co-Occurring Conditions: Promising Practices and Approaches.”

Co-occurring conditions are no longer the exception but the expectation, requiring treatment programs to design services that address the interrelationship among complex physical, psychiatric, and substance use conditions. This curriculum will review up-to-date principles, terminology, screening, assessment, treatment considerations, and programming guidelines, and the interactive program will engage participants through discussion and small group exercise. This six-hour virtual course is divided into two parts in DDAP’s Training Management System.

Participants of this course will:

  • Describe the foundations of integrated treatment;
  • Highlight key treatment considerations;
  • Employ screening and assessment for COD; and
  • Critique integrated treatment plans.

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) has added a third option to its list of approved ASAM Criteria education.

For more information on ASAM, visit DDAP’s website.