Mr. George J. Kimes
Executive Director
Pennsylvania Community Providers Association
2400 Park Drive
Harrisburg, PA 17110-9303
Dear Mr. Kimes:
Thank you for your letter of October 18, 2000, requesting a waiver of the Medical Assistance (MA) regulation requiring a physical examination in outpatient drug and alcohol treatment prior to the initiation of services to MA recipients.
The Office of Medical Assistance Programs (OMAP) developed a regulation package revising the physical examination requirement, which was submitted to the Medical Assistance Advisory Committee (MAAC) for public review and comment. During the public review and comment period, OMAP received comments from the Pennsylvania Psychiatric Society (PPS) requesting that the regulations provide for an examination and face-to-face evaluation by a physician when either the non-physician assessment or the physician's review indicates the need.
The regulations have been revised to reflect the PPS's request. OMAP must present the current revision of the regulations to the MAAC to ensure that the current revisions accurately reflect the needs of the PPS. This occurred during the MAAC meeting held December 14, 2000. Concurrently, OMAP is forwarding the regulation package, under separate cover, to the Pennsylvania Community Providers Association, the PPS and the Pennsylvania Psychological Association for review and comment. The aforementioned external review process is an integral part of the public input process that we follow.
It is our intent to finalize this regulatory package upon receipt and review of additional comments from the MAAC. The Department is to forward this package for the final review process and hopes to complete the review and publication by early summer. While we are confident that we have addressed the concerns of the PPS, due to the sensitivity of the issue, I am reluctant to grant the waiver. We do not want to presuppose any additional concerns.
If you have any additional questions, please feel free to contact Ms. Suzanne Love, Director, Bureau of Policy, Budget and Planning, at (717) 772-6147.
Sincerely,
Feather O. Houstoun
Secretary Feather O. Houstoun
Department of Public Welfare
Room 333, Health & Welfare Building
PO Box 2675
Harrisburg, PA 17105-2675
Dear Secretary Houstoun:
I am writing on behalf of the members of the Pennsylvania Community Providers Association (PCPA).
Attached is a series of letters between the Department of Public Welfare and PCPA over the last two years. The letters involve the Medical Assistance regulation for physical exams in outpatient drug and alcohol treatment.
It is our understanding that the issues mentioned in your letter of February 29, 2000 have been addressed and a revised regulation is in process. Once again, we ask you to issue a waiver until such time as the regulatory review process takes place. As you know, it can take a long time to change the regulation.
We were pleased to read in your letter of February 29 that OMAP strongly supports changing this regulation and hope now that the concerns expressed have been addressed that a waiver will be granted to end the unnecessary costs and the deterrent to needed treatment.
If you have any questions or need additional information please contact Lynn Cooper of my staff or me. Thank you for your consideration of this request.
George J. Kimes
Executive Director
Mr. Raymond R. Webb, Jr.
Acting Executive Director
Pennsylvania Community Providers Association
2400 Park Drive
Harrisburg, PA 17110-9303
Dear Mr. Webb:
Thank you for your letter of December 16, 1999, requesting a waiver of the Medical Assistance (MA) regulation requiring a physical examination in outpatient drug and alcohol treatment prior to the initiation of services.
The Office of Medical Assistance Programs (OMAP) is in agreement with the Pennsylvania Community Providers Association that the physical examination requirement is a problem in the drug and alcohol service delivery system. As a result, the Department of Public Welfare (Department) developed a Notice of Rule Change, Class IV Bulletin, that was in the Department's final review process. Unfortunately, the Department's Office of Legal Counsel advised OMAP that it is necessary, under the Commonwealth Documents Law, to amend this regulation through the Independent Regulatory Review Process.
OMAP developed a regulation package revising the physical examination requirement which was submitted to the Medical Assistance Advisory Committee for public review and comment on proposed changes to regulations. During the public review and comment period, OMAP received several comments which raised several issues concerning the physical examination which should be given every consideration prior to OMAP's final draft of regulation changes. The comments received from the public review process raised issues which must be addressed before OMAP can consider granting a waiver of the regulation requirement.
OMAP strongly supports changing the regulation for outpatient drug and alcohol clinics and is working as quickly as possible to address the issues raised and amending the regulation through the Independent Regulatory Review Process.
If you have any additional questions, please feel free to contact Ms. Suzanne Love, Director, Bureau of Policy, Budget and Planning, at (717) 772-6147.
Sincerely,
Feather O. Houstoun, Secretary
Department of Public Welfare
Secretary Feather O. Houstoun
Department of Public Welfare
Room 333, Health & Welfare Building
PO Box 2675
Harrisburg, PA 17105-2675
Dear Secretary Houstoun:
I am writing on behalf of the members of the Pennsylvania Community Providers Association (PCPA).
The purpose of this letter is to request a waiver. It is our understanding that waivers are granted by the Department of Public Welfare only in extreme cases. We strongly believe this is one of those cases.
The problem involves a Medical Assistance regulation for physical exams in outpatient drug and alcohol treatment. I have written to you and your staff on this issue on numerous occasions. Attached are copies of the correspondence.
This regulation is unnecessary, wasting state money and prohibiting clients from getting desperately needed treatment. We understand that DPW strongly supports changing the regulation but that we must go through the regulatory review process in order to change it. However, we believe that the Department should issue a waiver until such time as the regulatory review process takes place. As you know, it can take quite some time to get through the process.
Thank you for your consideration of this important request. We hope to hear from you soon about the possibility of the waiver.
Sincerely,
Raymond R. Webb, Jr., LSW
Executive Director
Ms. Suzanne Love
Office of Medical Assistance Programs
Department of Public Welfare
789 Eisenhower Blvd.
Harrisburg, PA 17111
Dear Ms. Love:
Don McCoy, of the Pennsylvania Medical Society, has shared with me the Department's draft changes to the Chapter 1223 regulations regarding physical examinations and initiation of treatment in outpatient drug and alcohol clinics.
We are very pleased that the changes incorporate the suggestions we made in out letter of December 16, 1999, in response to an earlier draft. The addition of a requirement for appropriate screening tools, and, most important, the flexibility to allow physician examination, represent major improvements over the original proposal. We support the specific language used in the draft, as well as the clarification that this policy does not apply in methadone clinics.
We would like to suggest one clarification, which I am sorry we did not specifically mention in our previous letter. That would be the addition of the words "or psychiatric" before "evaluation" in 1223.52 (a) 6 (iv), as follows: A physician may perform a physical examination and/OR PSYCHIATRIC evaluation when medically necessary as indicated by either the non-physician level of care determination or the on-site supervisory physician's review. We assume it is the Department's intention that the physician's evaluation referenced in this section would cover mental health and substance abuse issues, but we believe it would be very helpful to provide clarification through the insertion of "or psychiatric."
Again, I want to express our great appreciation for the Department's responsiveness to our initial concerns, and to the thoughtful approach you have taken to soling the problem brought to you by some of the D&A clinics. If we can be of any further help, please feel free to call me personally at (215) 471-2801, or our Executive Director, Gwen Lehman, at 717-558-7750, ext. 1471.
Sincerely yours,
Frederic M. Baurer, MD
Chair, Addiction Psychiatric Committee
Pennsylvania Psychiatric Society
Mr. George J. Kimes
Executive Director
Pennsylvania Community Providers Association
2400 Park Drive
Harrisburg, PA 17110-9303
Dear Mr. Kimes:
I am writing to you in regards to the Medical Assistance (MA) regulation requiring a physical examination in outpatient drug and alcohol treatment prior to the initiation of services to MA recipients.
The Office of Medical Assistance Programs (OMAP) developed a regulation package revising the physical examination requirement, which was submitted to the Medical Assistance Advisory Committee (MAAC) for public review and comment. During the public review and comment period, OMAP received comments from the Pennsylvania Psychiatric Society (PPS) requesting that the regulations provide for an examination and face-to-face evaluation by a physician when either the non-physician assessment or the physician's review indicates the need.
The regulations have been revised to reflect the PPS's request. OMAP must present the current revision of the regulations to the MAAC to ensure that the current revisions accurately reflect the need of the PPS. This occurred during the MAAC meeting held December 14, 2000. Concurrently, OMAP has enclosed the regulation package, for review and comment by the Pennsylvania Community Providers Association (PCPA). OMAP would like the PCPA to review and comment on the regulation package by December 29, 2000. Please forward comments on the regulation package to my attention.
It is our intent to finalize this regulatory package upon receipt and review of any additional comments from MAAC. I would like to thank PCPA for participating in the public review of the regulatory package. If you have further questions, please feel free to contact Ms. Maria Gerardi, of my staff, at (717) 772-6147.
Sincerely,
Suzanne Love
Director
Bureau of Policy, Budget and Planning
OMAP