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IRRC

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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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Image by Dirk Wouters from Pixabay

The Office of Mental Health and Substance Abuse Services (OMHSAS) has submitted to the Pennsylvania Independent Regulatory Review Commission (IRRC) IRRC No. 3417 — Psychiatric Residential Treatment Facilities (14-555) regulations for the first phase of the promulgation process.

At this time, the regulations will be open for the submission of public comments from November 2, 2024, to December 1, 2024. The IRRC will review these comments and work with OMHSAS on developing responses as well as any potential language changes.

This process for regulation development with stakeholders began in 2019, and RCPA and its members have been active partners with the OMHSAS Children’s Bureau in the ongoing process through forums and work group meetings. The RCPA Residential Services Work Group completed a cursory review of a PRFT regulation presentation by OMHSAS in July and will begin working on developing a full response to the regulations.

RCPA will be connecting with these members this week to schedule the PRTF Regulatory Review Team that will support our recommendations to the current draft. If any member is interested in participating in the review group, please contact RCPA COO and MH Director Jim Sharp.

The regulations can be view at the links below.

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The Pennsylvania Independent Regulatory Review Commission (IRRC) has completed their review of existing Intensive Behavioral Health Services (IBHS) regulations codified at 55PA. Code chapters 1155 and 5240, as requested by the RCPA IBHS Steering Committee.

The RCPA IBHS Regulatory Reform Recommendations, submitted on November 29, 2022, requested the commission to review the IBHS regulations under section 8.1 of the Regulatory Review Act, which provides that the commission may review any existing regulation which has been an effect for at least three years.

The commission has noted the burden placed on providers by the Department of Human Services regulation, but while they appreciated our concerns, the commission’s role is to determine whether existing regulations, as a whole, remain in the public interest. In the commission review letter, they determined that further action by the commission is not warranted in this matter.

We have been in contact with OMHSAS throughout this two-year period, and the commission provided the department with guidance as part of the review process. Despite the ruling from the IRRC, OMHSAS has agreed that they will reopen the IBHS for review as announced by OMHSAS Deputy Secretary Jennifer Smith at the RCPA Conference last week. RCPA will be reviewing the recommendations to calibrate those areas that continue to create barriers to access that have arisen since the recommendations created in the Fall of 2022.

If you have any questions, please contact RCPA COO and Policy Director Jim Sharp.

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Image by Dirk Wouters from Pixabay

As part of the Independent Regulatory Reform Commission (IRRC) process for the promulgation of new regulations, the Final Form Regulations for the Psychiatric Rehabilitation Services (PRS) have been posted for review and public comment on the IRRC website. This public comment period runs for 30 days. The comments may be submitted by individuals, organizations, associations, etc. on the impacts of the regulations on the systems and individuals they serve.

The purpose of this final-form rulemaking is to amend Chapter 5230 to allow psychiatric rehabilitation services (PRS) to be provided to individuals who are diagnosed with posttraumatic stress disorder, bipolar disorder, major depressive disorder, or anxiety disorders without going through the exception process and to allow individuals who are 14 years of age or older but under 18 years of age who meet the admission requirements to access PRS. In addition, the final-form rulemaking clarifies the documentation that will be reviewed through the exception process to determine if an individual is eligible for PRS as well as revises outdated language.

The Department convened a work group that included stakeholders to review and provide input on the proposed rulemaking. The work group held face-to-face meetings on November 4, 2015; December 8, 2015; and January 28, 2016, to review the current regulation and provide recommendations for the proposed changes, which RCPA and its members took part in.

At this time, we are seeking any further public comment as it relates to these regulations. RCPA intends to submit comments on behalf of our members, though individuals and organizations may submit comments pertaining to the regulations directly to the IRRC website. Please submit your comments to RCPA COO and Mental Health Policy Director Jim Sharp.

The IRRC hearing on the Final Form Regulation Hearing will be held on September 19, 2024, at 10:00 am. RCPA intends to participate in the hearing to speak to our recommendations. If any member would like to attend and or testify, please contact Jim Sharp.

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The Independent Regulatory Review Commission (IRRC) recently posted a proposed regulation from the Pennsylvania Department of State on behalf of the State Board of Physical Therapy (PT) for consideration.

The State Board of Physical Therapy (Board) proposes to amend §§ 40.1, 40.14, 40.15, 40.61, 40.63, 40.67, 40.163, 40.164, and 40.192. The proposed rulemaking will allow physical therapist (PT) students and physical therapist assistant (PTA) students to sit for the requisite examinations up to 90 days prior to graduation from their respective programs, and it will allow PTs and PTAs to receive a limited amount of continuing education credit for providing clinical instruction to student PTs and student PTAs at clinical facilities affiliated with accredited programs. Additionally, the proposed rulemaking will allow applicants to directly register for the national examination with the examination provider, by removing the requirement that the applicant first seek the Board’s permission. Lastly, it will allow applicants to sit for a third or successive examination, after two failures, without first seeking the Board’s permission.

The amendments will be effective upon notice or publication of the final-form rulemaking in the Pennsylvania Bulletin scheduled for January 27, 2024. The proposed regulation will be open for public comment upon publication, and comments will be accepted through February 26, 2024. Written comments, recommendations, or objections regarding this proposed rulemaking should be sent to Thomas M. Davis, Board Counsel, at P.O. Box 69523, Harrisburg, PA 17106-9523 or by email within 30 days of publication of this proposed rulemaking in the Pennsylvania Bulletin. Please reference “Regulation No. 16A-6522 (Early Exam, CE for Clinical Instruction, and AAP)” when submitting comments. IRRC comments on the proposed regulation will be due by March 27, 2024.

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A proposed regulation related to Adult Protective Services is currently posted on the Independent Regulatory Review Commission’s (IRRC) website. This proposed regulation “identifies mandatory reporters and prescribes penalties for their failure to report suspected abuse, neglect, exploitation, or abandonment; requires consistent and timely investigations of allegations; and when necessary, provides for protective services to mitigate risk to individuals.”

The public comment period has started and will end on May 22, 2023. Please take the opportunity to review the proposed regulation and submit any comments that you may have following the processes outlined within the timeframe allotted. Consider sharing your thoughts with Carol Ferenz or your policy division director by May 19, 2023, for inclusion in RCPA’s comments.

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Photo by Markus Winkler on Unsplash

The Pennsylvania Independent Regulatory Review Commission (IRRC) has approved RCPA’s request to review the RCPA IBHS Regulatory Review Recommendations within the context of the current IBHS regulations.

The premise of the recommendations addresses the challenges and barriers IBHS providers have faced in creating the staffing infrastructures and meeting the burdensome operational protocols for regulatory compliance. The overreaching nature of the regulations, coupled with the impact of the pandemic, has caused great strain on an already depleted behavioral health workforce. These system stressors limit the ability to provide vital, quality services to children and families. Due to the prohibition for the use of waiting lists, it is difficult to capture the true number of children and families going without these essential services. We contend there are thousands of children across the Commonwealth with unmet treatment needs and written orders for IBHS services who await care.

The current lack of access to care is a result of the workforce crisis and operational requirements of implementing the regulations. We feel these access issues and children waiting for services are compelling reasons, in the interest of the public, to merit a review of the regulations. We have also provided these recommendations to OMHSAS, the HealthChoices BHMCOs, and leadership in the Pennsylvania General Assembly.

RCPA extends its gratitude to our members and those who have supported this process as well as the IRRC for their review. There is no current timeframe for the review, as there are many other, similar regulatory review requests on the docket. With that said, we remain vigilant in our efforts and seek partnership and collaboration with all stakeholders to address the current crisis.

If you have any questions, please contact RCPA Mental Health Policy Director Jim Sharp.

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On behalf of the RCPA IBHS Providers and the children and families of Pennsylvania, RCPA has requested the Independent Regulatory Review Commission (IRRC) to reopen for review Regulation #14-546: Intensive Behavioral Health Services, based on section 8.1 of the Regulatory Review Act (71 P.S. § 745.8a).

The premise of our recommendations addresses the challenges and barriers IBHS providers have faced in creating the staffing infrastructures and meeting the burdensome operational protocols for regulatory compliance. The overreaching nature of the regulations, coupled with the impact of the pandemic, has caused great strain on an already depleted behavioral health workforce. These system stressors limit the ability to provide vital, quality services to children and families. Due to the prohibition for the use of waiting lists, it is difficult to capture the true number of children and families going without these essential services. We contend there are thousands of children across the Commonwealth with unmet treatment needs and written orders for IBHS services who await care.

The current lack of access to care is a result of the workforce crisis and operational requirements of implementing the regulations. We feel these access issues and children waiting for services are compelling reasons, in the interest of the public, to merit a review of the regulations.

The COVID-19 DHS regulatory flexibilities provided initial relief for providers, and OMHSAS continues to offer waivers to agencies experiencing critical staffing shortages. Providers are grateful for these temporary solutions; however, these waivers do not address the long-term impacts of the current regulatory requirements. Providers continue to struggle to hire qualified staff and contend with burdensome operational requirements, many of which negatively contribute to the efficiency of care delivery.

The expressed purpose of the IBHS regulations was to ensure access to quality care in a consistent and efficient manner. Conversely, the result has been a labyrinth of regulatory and operational interpretations, differentiated reimbursement for the same services, and a human services workforce crisis with no upcoming relief.

RCPA would like to thank the members of the RCPA IBHS Steering Committee for their commitment to conduct the review and the Commission for their willingness to consider this request. We believe these recommendations, if implemented, can address the barriers identified without compromising the original vision for high-quality services and broad access to care.

At last correspondence, the IRRC is in receipt of the recommendations. We will be providing a copy to the Office of Mental Health and Substance Abuse Services (OMHSAS), as requested by the Commission. We will continue to keep members apprised of the review process. If you have further questions, please contact RCPA Policy Director Jim Sharp.

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On Friday, October 1, the Department of Drug and Alcohol Programs (DDAP) resubmitted to the Independent Regulatory Review Commission (IRRC) its Final-Omitted Regulations on Standards for Drug and Alcohol Recovery House Licensure, as well as its response to IRRC’s disapproval order of Aug. 24, 2021.

The regulations are publicly available on IRRC’s website.

The submitted regulatory package includes the updated regulations (p. 98–129), as well as:

  • a regulatory analysis (p. 1–12);
  • IRRC’s disapproval order (p. 86–92);
  • DDAP’s response to IRRC’s disapproval order (p. 93–97);
  • a preamble that includes public comments and DDAP’s response to comments (p. 48–85);
  • a sample recovery house licensing application (p. 13–14);
  • a sample recovery house licensing checklist (p. 15–22); and
  • additional DDAP forms (p. 23–35), as well as a description of forms that must be provided by the recovery house (p. 36–46).

The above linked documents reflect the changes made to the regulations since DDAP appeared at IRRC’s public meeting in July. The revised regulations are scheduled to be considered at IRRC’s next public meeting on Thursday, October 21.

Upcoming Timeline:

  • DDAP expects that the new regulations will be in effect by October 2021.
  • DDAP expects to require compliance with the new regulations by April 2022.

Which Recovery Houses Will Need a License?

Once the new licensing program is in place, drug and alcohol recovery houses must have a license to:

  1. Receive referrals from state agencies or state-funded facilities; or
  2. Receive federal or state funding to deliver recovery house services.

In addition, the law imposes two additional requirements on referrals to recovery houses:

  1. People whose treatment is funded with state or federal funds shall only to be referred to licensed recovery houses.
  2. Courts shall give first consideration to licensed recovery houses when residential recommendations are made for individuals under their supervision.

Additional information on drug and alcohol recovery house licensing can be found here.

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On June 14, 2021, the Pennsylvania Department of Drug and Alcohol Programs (DDAP) resubmitted to the Independent Regulatory Review Commission (IRRC) its Final-Omitted Regulations on Standards for Drug and Alcohol Recovery House Licensure. As of yesterday afternoon, they are publicly available on IRRC’s website.

The submitted regulatory package includes:

  • the updated regulations (p. 49–78);
  • a regulatory analysis (p. 1–11);
  • a preamble that includes public comments and DDAP response to comments (p. 13–48);
  • a sample recovery house licensing application (p. 79–80);
  • a sample recovery house licensing checklist (p. 81–88);
  • additional DDAP forms (p. 89–101); and
  • a description of forms that must be provided by the recovery house (p. 102–112).

DDAP expects that the new regulations will be in effect by July 2021 and will require compliance with the new regulations by January 2022. More information on drug and alcohol recovery house licensing is available on DDAP’s website.

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