Pennsylvania Eases Rules for Drug and Alcohol Treatment Providers With New Virtual-Only License: RCPA SUD Treatment Services Policy Director Jason Snyder Quoted
Telehealth
DDAP Issues Licensing Alert to Detail Process for Outpatient Telehealth-Only Licensure
The Pennsylvania Department of Drug and Alcohol Programs (DDAP) today issued Licensing Alert 08-2024 to detail the steps for SUD treatment providers to obtain a telehealth-only license from the department.
These DDAP-licensed telehealth-only providers may provide intake, evaluation, and referral, as well as outpatient or partial hospitalization services, via telehealth only without a physical plant location in Pennsylvania to individuals who are located in the commonwealth as long as the provider complies with all applicable federal, state, and local laws. Any DDAP-licensed provider can also provide some telehealth services as an option to in-person treatment. However, only a telehealth-only provider may provide 100 percent of its treatment services via telehealth.
DDAP will not require the provider to maintain a physical location in Pennsylvania. DDAP also will grant all telehealth-only providers an exception to § 709.11(b) regarding the requirement to conduct an onsite inspection for the renewal of a license as part of licensure.
Licensing Alert 08-2024 applies only to DDAP licensure. Providers that are considering applying for a telehealth-only license should consult their public and private insurance payers to confirm whether they will meet conditions for network enrollment and payment, as DDAP cannot guarantee a DDAP-licensed telehealth-only provider funding or a contract.
The full licensing alert provides additional information, including how to apply for the license.
Contact RCPA SUD Treatment Services Policy Director Jason Snyder with any questions.
Pennsylvania Healthcare Summit to Be Held January 30, 2025
DDAP to Begin Licensing Telehealth-Only SUD Treatment Providers
Despite opposition and concerns from substance use disorder (SUD) treatment providers, single county authorities, primary contractors, and behavioral health managed care organizations, the Pennsylvania Department of Drug and Alcohol Programs (DDAP) will begin licensing telehealth-only SUD treatment providers.
DDAP will issue a licensing alert on Wednesday, December 4, detailing the new licensure category.
Organizations newly licensed under this tele-only category will be able to provide intake, evaluation, and referral services, as well as outpatient treatment, including partial hospitalization services, via telehealth only, without a physical plant location in Pennsylvania.
DDAP’s intention in licensing telehealth-only providers is to hold them to the same standards as facility-based providers as a way to ensure equity and maintain operational standards. DDAP will continue to monitor complaints and unusual incidents for all licensed providers, as well as the number of telehealth-only license applications that are made over time, looking for any trends that could require additional action.
RCPA and its provider members opposed creation of the new license, citing patient safety and quality concerns, as well as potential erosion of the community-based provider system. RCPA hosted DDAP for a discussion about its concerns, met one-on-one with the department, and provided written feedback to DDAP. In addition, RCPA met with the governor’s Policy Office, to discuss provider concerns.
DDAP will attend RCPA’s next SUD Committee meeting at 11:00 am on Tuesday, December 10. RCPA has asked DDAP to discuss the new license category. RCPA members wanting to attend this meeting can register here.
DDAP Issues Bulletin in Response to Federal Extension of Telemedicine Flexibilities
As RCPA previously communicated, the Drug Enforcement Administration (DEA), jointly with the U.S. Department of Health and Human Services (HHS), has extended the temporary COVID-19 telemedicine flexibilities through December 31, 2025. These flexibilities enable prescribing of controlled medications via telemedicine. As such, the Pennsylvania Department of Drug and Alcohol Programs’ (DDAP) suspension of 28 Pa. Code § 715.9(a)(4), which allows an initial evaluation for a person who will be treated by an opioid treatment program (OTP) with buprenorphine to be completed via telehealth, is also extended.
DDAP’s complete Information Bulletin 03-2024 is available here.
New CHC and OBRA Waiver Services Announced, Effective January 1, 2025
The Office of Long-Term Living (OLTL) has announced new services that will be available as a result of the Community HealthChoices (CHC) Waiver renewal and OBRA Waiver renewal. Effective January 1, 2025, the following services will be available:
Chore Services – CHC Only
- Provider Type: 59
- Specialty Code: 431
- Procedure Code: S5131
Teleservice Cognitive Rehabilitation Therapy – CHC and OBRA
- Provider Type: 59
- Specialty Code: 207
- Procedure Code: W0176
Teleservice Counseling Services – CHC and OBRA
- Provider Type: 59
- Specialty Code: 231
- Procedure Code: W0175
Teleservice Nutritional Consultation – CHC and OBRA
- Provider Type: 59
- Specialty Code: 230
- Procedure Code: W0170
The rates for the OLTL Home and Community-Based Services (HCBS) rates, effective January 1, 2025, are available here.
Additional information on the licensure and certification requirements can be found in the Service Definitions under Appendix C of the waivers. Please note that these documents have not received final approval from the Centers for Medicare & Medicaid Services (CMS). Once approval is received, a ListServ message will be sent with links to the final approved waiver applications.
- OBRA Waiver Amendment: OBRA Waiver Amendment | Department of Human Services | Commonwealth of Pennsylvania
- CHC Waiver Renewal: CHC Waiver Amendment | Department of Human Services | Commonwealth of Pennsylvania
The Fee for Service rates for Teleservice Cognitive Rehabilitation Therapy, Teleservice Counseling Services, and Teleservice Nutritional Consultation have been added to the fee schedule attached to the ListServ.
For existing OLTL providers to enroll in the services listed above a request must be submitted to the enrollment and certification resource account. The required documentation should include an updated Provider Enrollment Information Form (PEIF), a copy of the required license or certification, and a copy of the job description for the service you are requesting to add to your provider profile. If you have any questions related to the new services you can reach out to the enrollment and certification unit at 1-800-932-0939, option 1, or via email.
OMHSAS Provides Updated Telehealth Guidance on “Four Walls”
On Friday, November 1, the Centers for Medicare & Medicaid Services (CMS) released an anticipated Final Rule titled “CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC),” which includes three new exceptions for the federal “four walls” rule. At present, the “four walls” rule prohibits Medicaid payment for clinic services when both the practitioner and individual receiving service are outside of the “four walls” of the clinic unless the services are being provided to unhoused individuals (such as through street medicine). The new exception for Indian Health Services and Tribal Facilities is required nationally. The exceptions for Behavioral Health Clinics and Rural clinics are optional. States who determine that their Behavioral Health Clinic and/or Rural Health Clinic populations served meet the four criteria established by CMS (see page 1323 of the final rule) must submit a Medicaid State Plan Amendment (SPA) and receive approval from CMS for these exceptions to be in place for their state.
The Office of Mental Health and Substance Abuse Services (OMHSAS) had been working toward a short-term state level solution to the four walls issue for both Outpatient Psychiatric Clinics and Drug and Alcohol Clinics. However, now that a long-term federal option has been made available, the team in OMHSAS will be pivoting to pursue this newly available federal exception for Behavioral Health Clinics. While OMHSAS is still in the process of developing a timeline for the new State Plan Amendment, their team will be working on this as a top priority, with the goal of having a SPA in place in early 2025.
It has been confirmed that OMHSAS will not be shifting their current enforcement policy around the four walls while they work through getting this waiver in place. RCPA will continue its collaboration with OMHSAS on the process as this move forwards. If you have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.
For additional information, please see the following:
- Full Final Rule
- CMS FAQ on the Final Rule
- Email for Questions Regarding OMHSAS Telehealth Policy
National Council Releases Five-Year Strategic Plan
DEA Expected to Extend Telehealth Flexibilities for Controlled Substances a Third Time
This week, the Drug Enforcement Agency (DEA) submitted a final rule regarding virtual prescribing of controlled substances to the White House’s Office of Management and Budget (OMB). Though the final rule is not yet publicly available, the OMB registry posting, titled “Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications,” suggests an extension is coming that will go beyond the current expiration date of December 31, 2024.
Without a new rule or extension of the current flexibility beyond December 31, virtual prescribing of controlled substances without a prior in-person evaluation would no longer be allowed.
DEA received more than 38,000 public comments following its proposed rule in February 2023 for telemedicine prescribing of controlled substances. Subsequently, the telehealth flexibilities were extended to the current December 31, 2024, expiration date.
RCPA will continue to monitor progress on the final rule and communicate the details of the final rule once it is made public.
DOS, DDAP Poised to Enable Tele-Induction of Narcotic Medications at OTPs
Last Thursday (October 3, 2024), the Pennsylvania Department of State’s Board of Medicine submitted to the Independent Regulatory Review Commission (IRRC) a final-omitted regulation that would allow an initial physical examination required for prescribing, administering, and dispensing controlled substances to be conducted via telehealth under certain circumstances under 49 Pa. Code § 16.92. A final-omitted regulation does not require a public comment period and is in essence an expedited process for proposing a regulation change. IRRC will hold a public meeting on November 21 to approve or disapprove the regulation.
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.
In its Regulatory Analysis Form, the Department of State’s Board of Medicine wrote:
“This final-omitted rulemaking amends the Board’s regulations at § 16.92 by allowing the initial physical examination required for prescribing, administering, and dispensing controlled substances to be conducted by means of telehealth for those patients being admitted into an Opioid Treatment Program (OTP) for treatment of opioid use disorder with either buprenorphine or methadone, provided that the health care provider determines that an adequate evaluation of the patient can be accomplished via telehealth and a full in-person physical examination is completed within 14 days after admission to the OTP. This standard is the same physical examination standard utilized as a result of the Bureau of Professional and Occupational Affairs regulatory waiver issued during the COVID-19 epidemic, which proved to be safe and effective during and after the COVID-19 epidemic. This final-omitted regulation also conforms the Board’s regulations to the Federal opioid use disorder treatment standards as the Board does not wish to unnecessarily maintain a more stringent standard than required by Federal law for OTPs given the continued opioid crisis in this Commonwealth.”
In February 2024, the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) published a final rule amending the federal regulations for the certification of OTPs in 42 CFR Part 8. The changes to the federal rules were used temporarily to improve access to treatment during the COVID-19 federal public health emergency. SAMHSA has now made those changes permanent, and DDAP intends to implement the updated federal rules and reduce barriers to treatment, as described in its latest Licensing Alert 07-2024. This final-omitted regulation is part of the commonwealth’s process for aligning with the final rule on 42 CFR Part 8.
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