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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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By MEDIANEWS GROUP
PUBLISHED: 
NORRISTOWN — The Montgomery County Intermediate Unit has been awarded a $7.2 million four-year grant by the Substance Abuse and Mental Health Services Administration.

This highly competitive Project AWARE grant, for which the intermediate unit will receive $1.8 million a year for four years, has only been awarded to approximately 20 entities across the United States.

Project AWARE is a nationwide grant created to develop a sustainable infrastructure for school-based mental health programs and services. The intermediate unit provides programs and services to Montgomery County school districts, career and technical schools, non-public schools and other organizations. Through its direct service to students, especially those most at risk, the intermediate unit has been able to identify ways to assist students and their families to navigate mental health supports and services.

“This grant award is a major recognition for the MCIU and reflects all the hard work and accomplishments of our MCIU employees in supporting students and families across the region,” Executive Director Regina Speaker said in a press release issued by the Intermediate Unit. “We appreciate the support of Senator Robert Casey and Congresswoman Madeleine Dean and many other partners, including the Pennsylvania Department of Education, for this grant project.”

The grant project will: expand suicide awareness training opportunities for students(K-12), implement a universal mental health screener to be utilized by school district or nonpublic school staff members and create an electronic data system to connect school mental health practitioners (e.g. psychologists, social workers and counselors) with community-based mental health providers that have immediate availability to support students in all levels of care (outpatient therapy to inpatient psychiatric care).

The MCIU is partnering with two other intermediate units on this project — Luzerne and Carbon-Lehigh County Intermediate Units — to proactively address students’ mental health needs.

RCPA recommends members in the Montgomery County region engage with the Montgomery County Intermediate Unit and local school districts for planning and discussions on how your continuum of services may benefit student mental health in the schools.

If you have further questions, please contact RCPA Children’s Mental Health Director Jim Sharp.

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The Office of Management and Budget (OMB) has released the Unified Regulatory Agenda and Regulatory Plan, which outlines regulatory actions federal agencies are considering in the coming months. Regulations can be searched by specific agency, such as Department of Health and Human Services (HHS), which includes the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is proposing to expand access to treatment for opioid use disorder (OUD) by making permanent medication flexibilities put in place during the COVID pandemic, including an increase in number of take-home doses of methadone and the use of telehealth in initiating buprenorphine at opioid treatment programs (OTPs).

In its Notice of Proposed Rulemaking to update 42 CFR Part 8, SAMHSA is proposing to improve access to OUD treatment through OTPs. The proposed changes reflect the widespread desire by many stakeholders for SAMHSA to provide greater autonomy to OTP practitioners, positively support recovery, and continue flexibilities that were extended at the start of the nation’s COVID-19 public health emergency. For example, in March and April 2020, SAMHSA published flexibilities for the provision of take-home doses of methadone and for the use of telehealth in initiating buprenorphine in OTPs. Patients deemed stable by physicians have been able to take home up to 28 days’ worth of methadone doses; other patients — again, so determined by their physicians — received up to a 14-day supply. A recent study showed that patients who received increased take-home doses after federal flexibilities were enacted during COVID-19 saw positive impacts on their recovery, including being more likely to remain in treatment and less likely to use illicit opioids.

Read the full announcement.

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The U.S. Department of Education’s Office of Special Education and Rehabilitative Services is pleased to release “A Framework for Community Engagement – A Pathway to Competitive Integrated Employment.” Developed in partnership with ODEP and the U.S. Department of Health and Human Services’ Administration for Community Living as well as the Substance Abuse and Mental Health Services Administration, this paper, targeted at both policymakers and service providers, explains what community engagement means along with its benefits. In addition, it contains information about the wide variety of services that, when provided together, expand opportunities for youth and adults with disabilities to achieve competitive integrated employment.

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