HR Committee: August 13 Meeting Follow-Up
Telehealth
HB 1590 “4 Walls” Telehealth Legislation Passes House
Message from Rep. Dan Williams’s Office:
HARRISBURG, June 24 – Bipartisan legislation introduced by state Rep. Dan Williams, D-Chester, that would help Pennsylvanians take advantage of new federal Medicaid rules that give patients and clinicians more telehealth options for behavioral health services passed the PA House today with overwhelming support.
“The longstanding and outdated ‘four walls’ requirement has limited Medicaid reimbursement to services within the physical walls of a clinic,” said Williams. “This only creates barriers to care, particularly in rural areas and regions experiencing mental health workforce shortages.”
The Centers for Medicare and Medicaid Services gave states the option to waive the requirement on Jan. 1. In response, the Pennsylvania Department of Human Services has submitted a State Plan Amendment to adopt this flexibility, which is currently awaiting federal approval.
House Bill 1590 would repeal state regulations that conflict with the new federal flexibility. Importantly, the bill would not change existing rules requiring in-person treatment hours for outpatient behavioral health clinics.
“Under this bill, Pennsylvania can fully implement the change, expanding access to behavioral health services and reducing care gaps for our vulnerable populations across the Commonwealth,” Williams said.
The bill now moves to the state Senate for consideration.
It is important to note that, at this time, OMHSAS is awaiting approval from CMS. To address the Federal Medicaid payment conditions in the Pennsylvania statute, there was a need for this legislation to permit services be covered under Medicaid, and HB 1590 would achieve this. It is also important to reiterate that this bill will not change outpatient behavioral health clinic rules requiring in-person treatment hours. The passage of this bill will address these conditions for outpatient clinics as well as the delivery of SUD services.
Both the CMS SPA approval and the legislation would be retroactive to January 1, 2025.
Until then, the completion of both the SPA and the legislation on 4 walls flexibilities will remain in place. RCPA is grateful to have partnered with OMHSAS, House legislators, and other stakeholder associations on the development of this bill. We will continue our efforts in getting the legislation to the Governor’s desk.
If you have any questions, please contact RCPA COO and Director of Mental Health Services Jim Sharp.
DDAP Issues First Telehealth-Only SUD License
The Pennsylvania Department of Drug and Alcohol Programs (DDAP) announced today that the agency recently issued Pennsylvania’s first telehealth exceptions for a DDAP-licensed substance use disorder (SUD) treatment provider in Pennsylvania to Gateway Rehabilitation Center (GRC).
In its press release, DDAP said that telehealth and mobile treatment options have been proven to reduce barriers like transportation, stigma, and provider shortages, especially in rural and underserved communities.
GRC has been an SUD treatment provider in Pennsylvania since 1972. Its telehealth-only program will provide a secure patient portal, an interactive app, encrypted messaging, appointment reminders, resources, education, and a virtual telehealth suite that offers SUD counseling, psychiatric services, medication-assisted recovery, preventive care, and coordination to other levels of care as needed.
Prior to the creation of the telehealth-only licensure category in December 2024, only SUD treatment facilities with a physical location in Pennsylvania could apply to DDAP for a license to also offer telehealth services. This new program does not require a physical location for a treatment provider to administer telehealth services.
A facility seeking to be licensed to provide telehealth-only services, without a physical location, will be required to, among other things:
- Maintain clinical records on a web-based electronic health record program;
- Maintain an electronic system for personnel files, including training records; and
- Agree to provide DDAP remote access to the facility files and client records any time access is requested in accordance with 42 CFR 2.53 — Audit and Evaluation.
HB 1590 “4 Walls” Telehealth Legislation Passes House
Message from Rep. Dan Williams’s Office:
HARRISBURG, June 24 – Bipartisan legislation introduced by state Rep. Dan Williams, D-Chester, that would help Pennsylvanians take advantage of new federal Medicaid rules that give patients and clinicians more telehealth options for behavioral health services passed the PA House today with overwhelming support.
“The longstanding and outdated ‘four walls’ requirement has limited Medicaid reimbursement to services within the physical walls of a clinic,” said Williams. “This only creates barriers to care, particularly in rural areas and regions experiencing mental health workforce shortages.”
The Centers for Medicare and Medicaid Services gave states the option to waive the requirement on Jan. 1. In response, the Pennsylvania Department of Human Services has submitted a State Plan Amendment to adopt this flexibility, which is currently awaiting federal approval.
House Bill 1590 would repeal state regulations that conflict with the new federal flexibility. Importantly, the bill would not change existing rules requiring in-person treatment hours for outpatient behavioral health clinics.
“Under this bill, Pennsylvania can fully implement the change, expanding access to behavioral health services and reducing care gaps for our vulnerable populations across the Commonwealth,” Williams said.
The bill now moves to the state Senate for consideration.
It is important to note that, at this time, OMHSAS is awaiting approval from CMS. To address the Federal Medicaid payment conditions in the Pennsylvania statute, there was a need for this legislation to permit services be covered under Medicaid, and HB 1590 would achieve this. It is also important to reiterate that this bill will not change outpatient behavioral health clinic rules requiring in-person treatment hours. The passage of this bill will address these conditions for outpatient clinics as well as the delivery of SUD services.
Both the CMS SPA approval and the legislation would be retroactive to January 1, 2025.
Until then, the completion of both the SPA and the legislation on 4 walls flexibilities will remain in place. RCPA is grateful to have partnered with OMHSAS, House legislators, and other stakeholder associations on the development of this bill. We will continue our efforts in getting the legislation to the Governor’s desk.
If you have any questions, please contact RCPA COO and Director of Mental Health Services Jim Sharp.
OMHSAS Updates Behavioral Health MA Fee Schedule: Telehealth Group Psychotherapy Codes Added
Last year, RCPA met with its provider members regarding the provision of group psychotherapy services via telehealth in the client’s home. RCPA then met with the Office of Mental Health and Substance Abuse Services (OMHSAS) to discuss the possibility of allowing this flexibility in an effort to fully realize the use of telehealth technology to enhance access.
Today, the Department of Human Services’ Medical Assistance (MA) Bulletin #99-25-02 outlines revisions to the MA fee schedule. The following changes are specific to behavioral services and are effective May 1, 2025:
- Procedure code 99452 (Interprofessional Services) is now open for provider type (PT)/Specialty combination 08/184 (Outpatient Drug and Alcohol).
- Place of Service (POS) 10 — Telehealth Provided in Patient’s Home is now available to use with the procedure code 90853 (group psychotherapy) for PT/Specialty combination 08/110 (Psychiatric Outpatient).
Please see the section titled “Behavioral Health Services” on page 6 of the bulletin for additional information related to these revisions.
If you have questions about these changes, please reach out to OMHSAS electronically or RCPA COO and Policy Director Jim Sharp.
Congress Passes Continuing Resolution; Updates on Medicare and Medicaid Released
StationMD Hosting “Managing Agitation for People With I/DD” Webinar on March 13
The Office of Developmental Programs (ODP) has shared an important training announcement from StationMD, a physician service that is dedicated to individuals with Intellectual and/or Developmental Disabilities (I/DD) and other vulnerable populations.
StationMD is inviting people to participate in a webinar on
“Managing Agitation for People With I/DD.”
The webinar will include:
- General information about the Specialty Telehealth and Assessment Team (STAT) Waiver service in Pennsylvania;
- A presentation from StationMD’s Co-Founder, Dr. Maulik Trivedi on the topic, “Managing Agitation for People with I/DD;” and
- Additional time for questions and answers.
Date:
Thursday, March 13, 2025, from 1:00 pm – 2:00 pm
This webinar qualifies for one training hour. To receive a certificate for the training hour after the webinar, please register in the link below.
Register Now!
Questions about this training may be sent electronically.
Dual Diagnosis Professional Conference Series on Revolutionizing Care on March 12
Final Rule on Teleprescribing of Schedule III-V Drugs for OUD, Including Buprenorphine, Released; Effective Date Remains In Question
Separate Notice of Proposed Rulemaking Would Completely Eliminate In-Person Evaluation for Prescribed Medications
The Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Agency (DEA) this month released three new prescribing-related telehealth rules.
The Final Rule On the Expansion of Buprenorphine Treatment Via Telemedicine Encounter authorizes DEA-registered practitioners to prescribe Schedule III-V controlled substances, including buprenorphine, for opioid use disorder, through an audio-only encounter for an initial six-month supply (split among multiple prescriptions over six calendar months). Although the rule has been published in the Federal Register and is set to take effect February 18, 2025, President Trump issued a regulatory freeze pending review that requires executive departments and agencies to consider postponing the rule’s effective date for 60 days to review “any questions of fact, law, and policy that the rules may raise.”
Under this final rule, practitioners must first review the patient’s prescription drug monitoring program data for the state in which the patient is located during the telemedicine encounter. Additional prescriptions can be issued under other forms of telemedicine as authorized under the Controlled Substances Act, or after an in-person medical evaluation is conducted. SAMHSA advises practitioners to check with their state medical boards about what specific telemedicine practices are currently authorized for prescribing controlled medications after this six-month period. RCPA has reached out to the Pennsylvania Department of State to determine whether there are telemedicine pathways in place to enable prescribing beyond the initial six-month period without an in-person examination.
This regulation also requires the pharmacist to verify the identity of the patient prior to filling a prescription. This final rule does not apply to practitioners who have already evaluated their patient in person.
Separate Proposed Rule Would Completely Eliminate In-Person Evaluation for Prescribed Medications
However, a separate proposed rule on Special Registrations for Telemedicine and Limited State Telemedicine Registrations would establish special registrations that will permit a patient to receive prescribed medications through telemedicine visits without ever having an in-person medical evaluation from a medical provider. According to the DEA, the special registration is available to medical providers who treat patients for whom they will prescribe Schedule III-V controlled substances. An Advanced Telemedicine Prescribing Registration is available for Schedule II medications when the medical practitioner is board certified in one of the following specialties: psychiatrists; hospice care physicians; physicians rendering treatment at long term care facilities; and pediatricians for the prescribing of medications identified as the most addictive and prone to diversion to the illegal drug market. This regulation allows specialized medical providers to issue telemedicine prescriptions for Schedule II-V medications.
DEA is seeking public comment by March 18, 2025, on additional medical specialists that should be authorized to issue Schedule II medications. Public comments will also be requested on additional patient protections for the prescribing of Schedule II medications by telemedicine, including whether the special registrant should be physically located in the same state as the patient being prescribed Schedule II medications; whether to limit Schedule II medications by telemedicine to medical practitioners whose practice is limited to less than 50 percent of prescriptions by telemedicine; and the appropriate duration needed for the rules’ provisions to be enacted.
For the first time, online platforms that facilitate connections between patients and medical providers that result in the prescription of medications will be required to register with DEA. This is critical, as DEA has found some unscrupulous medical providers on online platforms have used flexible telemedicine rules to put profit ahead of the well-being of patients.
The special registration rule will also require the establishment of a national PDMP to help the health industry protect against abuse and the diversion of controlled substances into the illegal drug market. A national PDMP will provide pharmacists and medical practitioners with visibility of a patient’s prescribed medication history.
Additionally, a Final Rule on Continuity of Care Via Telemedicine for Veterans Affairs (VA) patients was issued, allowing practitioners acting within the scope of their VA employment to prescribe controlled substances via telemedicine to a VA patient with whom they have not conducted an in-person medical evaluation. VA practitioners are permitted to prescribe controlled substances to VA patients if another VA practitioner has, at any time, previously conducted an in-person medical evaluation of the VA patient, subject to certain conditions.
OMHSAS Releases Peer Support Services Bulletin and Provider Handbook
The Office of Mental Health and Substance Abuse Services (OMHSAS) has released the OMHSAS-24-05 Peer Support Services (PSS) Bulletin and PSS Provider Handbook, updating the requirements for Peer Support Services. OMHSAS significantly reorganized the existing language in the Handbook to better clarify which requirements apply to OMHSAS licensure and which apply to Medical Assistance payment. Along with these formatting changes, OMHSAS-24-05 includes the following updates:
- Staff Qualifications and Requirements for Certified Peer Specialists (CPS)
- The requirement for a CPS to have a high school diploma or GED has been removed.
- The requirement for a Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED) has been replaced with a requirement to have a mental health diagnosis. Please note, to be eligible to receive PSS services, there is still a requirement for “the presence or history of an SMI or SED.”
- The clause requiring CPSs “to attain certification through the PCB within six months of hire” has been removed, as the certification examination is now available on-demand, eliminating the need for a grace period for testing to be completed.
- Staff Qualifications and Requirements for CPS Supervisors
- Adding a new qualification category for individuals with an associate degree.
- Supervisory meetings held in an audio-only format shall not be considered supervision.
- Supervisory meetings shall be provided at a minimum of one hour each week.
- Telehealth
- The prior requirement that only 25% of total services provided per beneficiary per calendar year can be delivered by telephone has been removed.
- PSS may be provided via telehealth technology, including audio-only service delivery, when it is clinically appropriate to do so.
- PSS providers must ensure that the preference of individuals receiving services (or their legal guardian) is given a high priority when determining the appropriate service delivery modality.
Please review all other revisions to OMHSAS-24-05 here.
Comments and questions regarding this bulletin should be directed to:
Office of Mental Health and Substance Abuse Services, Bureau of Policy, Planning and Program Development,
P.O. Box 2675,
Harrisburg, PA 17105
General Office Number: 717-772-7900
Email
If you have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.
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