Authors Posts by Jack Phillips

Jack Phillips

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Mr. Phillips is responsible to assist the association with health policy, which primarily includes member communication and advocacy with the Governor’s office, General Assembly, and state regulatory agencies. Mr. Phillips was most recently at the Pennsylvania Department of State as Director of Legislative Affairs.

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This alert contains information from both the National Council for Behavioral Health and the American Medical Rehabilitation Providers Association (AMRPA).

On Monday, President Trump unveiled his Fiscal Year (FY) 2020 budget request — calling for a $4.7 trillion decrease in federal spending and detailing his Administration’s priorities for next year. The document revives efforts to block grant Medicaid and restrict eligibility, maintains spending to combat opioid addiction, and outlines other major health care priorities. As with most presidential budgets, this proposal stands little chance of being enacted into law as written. Instead, the President’s budget proposal will act more as a messaging tool to Congress, which is currently working to develop and pass a budget for FY 2020 over the next few months.

It is important to note that it is the role of Congress, not the President, to design and pass the federal budget. As with the President’s previous two budgets, this year’s ambitious spending cuts are unlikely to gain traction in Congress. Regardless, they present a starting point for the budget and appropriations processes and outline President Trump’s priorities as he navigates a divided Congress. It remains to be seen if any of the President’s recommendations (detailed below) will be taken up by Congressional appropriators as they move through the budget process.

Among the highlights of the President’s budget request for the Health and Human Services Department (HHS) for FY 2020:

Medicaid – Particularly notable among Medicaid proposals in the President’s budget are a requirement for all states to institute work requirements as a condition of enrollment and to eliminate the Medicaid expansion contained in the ACA. Earlier Kaiser Family Foundation estimates have found that a nationwide rollout of Medicaid work requirements could cost between 1.4 and 4 million individuals their health care coverage. Furthermore, the budget calls for Medicaid spending to be redirected into block grants or for per-capita caps to be imposed.

Although Congressional Republicans and the Administration have previously proposed to convert the Medicaid program to block grants through Graham-Cassidy and similar legislation, the Administration has recently given indications that it could attempt to implement block grants for some states through 1115 waiver authority. The budget also calls once again for passing legislation similar to the Graham-Cassidy bill, however, the chances for legislation that would make major changes to Medicaid and/or the Affordable Care Act passing the Democratic-controlled House are nonexistent.

Opioid Crisis — The budget would keep funding for a response to the opioid epidemic relatively flat. The Administration calls for the continuation of the $1.5 billion in State Opioid Response (SOR) grants, the same amount as FY 2019. The budget also asks for $1 billion for the NIH’s opioid and pain research programs, to set minimum standards for drug utilization review (DUR) programs, and $221 million to support and grow the behavioral health workforce. Of the funding to support the behavioral health workforce, $4 million would be set aside to train providers to prescribe medication-assisted treatment (MAT) for opioid use disorders. Additionally, the Administration proposes to continue funding Substance Abuse Prevention and Treatment block grants at $1.85 billion.

ONDCP – Trump’s fiscal 2020 budget blueprint for the third year in a row proposes slashing the White House’s Office of National Drug Control Policy’s (ONDCP) budget by more than 95 percent by moving the office’s two major grant programs into other federal agencies. The $100 million Drug Free Communities program would be folded into the Substance Abuse and Mental Health Services Administration (SAMHSA) while the $254 million High Intensity Drug Trafficking Areas grant would be transferred to the Department of Justice.

Mental Health — The President’s budget calls for $723 million (a $13 million increase) for the Community Mental Health Services Block Grant and $150 million for Children’s Mental Health Services, all level funding from FY 2019. Importantly, the President once again endorsed Certified Community Behavioral Health Clinics (CCBHC) model to care for people with serious mental illness and addiction, calling for level funding for CCBHC expansion grants at $125 million. In response to the Parkland school shooting, the budget also includes $133 million for school violence prevention efforts, which include school safety programs as well as trainings within schools for school personnel to better recognize the signs and symptoms of mental illness in students, such as Mental Health First Aid.

In total, SAMHSA sees its budget reduced by $62 million to $5.5 billion total. Some of that savings comes from regional substance abuse prevention and treatment programs and programs that provide advocacy for individuals with mental illnesses. Notably, the proposal eliminates the Primary and Behavioral Health Care Integration grants, a program that supports providers in implementing integrated care. The National Council will advocate for continued funding of this important program that improves care for individuals with co-occurring behavioral and physical health conditions.

NIH Funding — The budget rolls out the President’s initiative to end the HIV epidemic, a hallmark of his 2019 State of the Union address. HHS would receive $291 million for the initiative, including $140 million to the CDC for diagnosis and testing. The NIH would see an overall budget cut of approximately $5.5 billion.

Post-acute care providers – Unified PAC Payment System. The Budget proposes to “address excessive payment for post-acute care providers by establishing a unified payment system based on patients’ clinical needs rather than the site of care.” The Budget table shows savings from the reform beginning in FY 2020. The HHS Budget-in-Brief explains that the proposal will provide lower annual Medicare payment updates to SNFs, HHAs, and IRFs beginning in FY 2020 through FY 2024. In FY 2025, HHS would implement a unified post-acute care payment system for SNFs, HHAs, IRFs, and LTCHs. The payment rates would be budget neutral in FY 2025, risk adjusted, and established prospectively annually. According to HHS, the episode grouping and pricing would be based on the average cost for providing post-acute care services for a diagnosis, similar to the DRG methodology for inpatient hospitals. The proposal provides the Secretary with authority to adjust payments based on quality of care, geographic differences in labor and other costs, as well as other factors as determined appropriate.

Additional details on the President’s HHS budget request are outlined in the Department’s budget-in-brief document.

Questions, contact RCPA Director of Government Affairs Jack Phillips.

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(From DHS news room)

Wolf Administration: Trump-Proposed Cuts to Federal Health Programs Jeopardize Access to Life-Saving Health Care

Harrisburg, PA – The Wolf Administration today spoke out against potential cuts contained in President Trump’s proposed federal budget, which would significantly change Medicare, Medicaid, and the Affordable Care Act. In total, these programs help more than 5.5 million older, working, and low-income Pennsylvanians access routine and life-saving health care.

Under President Trump’s proposed budget, Medicaid expansion, which currently covers nearly 700,000 Pennsylvanians, would be eliminated. Medicaid would also be converted from an entitlement program that provides coverage to all who are eligible to block grant allocated to states based on a per-person funding cap.

“Medicaid allows more than 2.8 million Pennsylvanians to access health care coverage that would otherwise be unaffordable or inaccessible. Changing the program to a block grant system and eliminating the Medicaid expansion would result in significant losses of coverage and more people being unable to access the care they need to stay healthy,” said Human Services Secretary Teresa Miller.

The federal budget also proposes a nationwide work requirement for able-bodied, working-age Medicaid recipients, requiring them to find work, train for work, or volunteer in order to maintain coverage. This requirement would be similar to what is in place for Temporary Assistance for Needy Families (TANF) recipients, a program the Wolf Administration is currently redesigning to address barriers to employment and encourage better long-term employment outcomes for TANF recipients.

“A work requirement doesn’t get a person a job — let alone a family sustaining job. It jeopardizes their access to health care and other essential needs, and without the investment needed to assist them to address the factors that can hold them back, they continue to be stuck in a cycle of poverty and poor health,” said Secretary Miller. “Governor Wolf is redesigning Pennsylvania’s employment and training programs to better address the barriers that prevent people from obtaining family-sustaining jobs. The federal government should follow this work rather than creating another barrier to good health.”

The President’s proposed budget also encourages implementing the ACA replacement proposed by Senators Bill Cassidy and Lindsey Graham, which would end protections against inflated pricing for older consumers, tax credits for plans purchased through the health insurance exchange, and essential health benefits, among others. The plan was previously called a step backwards by the Wolf Administration in 2017.

“Pennsylvania’s uninsured rate is at an all-time low of just 5.5 percent, down from more than double digits before the Affordable Care Act took effect. Governor Wolf and I continue to strive to ensure all Pennsylvanians have access to coverage that is both affordable and comprehensive. Unfortunately, this budget would move in the opposite direction,” Insurance Commissioner Jessica Altman said. “We need to build upon the progress we have made, and not look to policies like those contained in President Trump’s budget proposal that could jeopardize the coverage gains we have made and the health care programs millions of Pennsylvanians rely on.”

Commissioner Altman noted for 2019, the aggregate statewide premium for individual ACA plans fell by 2.3 percent, a new insurer entered the state, and consumers in 30 counties had more options than in 2018, all indicating Pennsylvania’s individual health insurance market is moving toward stabilization.

“Under the Older Americans Act, the Department of Aging is responsible for serving as a visible and effective advocate on behalf of older Pennsylvanians,” said Acting Secretary of Aging Robert Torres. “President Trump’s proposed budget is the antithesis of what our seniors need and deserve.”

The budget proposes a 20% decrease in funding to the National Family Caregiver Support Program, a 26% percent decrease in funding to the State Health Insurance Assistance Program, and the elimination of funding for the Senior Community Services Employment Program and Elder Falls Prevention.

The administration called on President Trump and Congress to work together on federal health plans that break down barriers to work without jeopardizing vulnerable Pennsylvanians’ access to health care.

“Although this proposal is unlikely to pass Congress in this form, the spirit of this proposed budget still presents a cruel agenda that would jeopardize access to quality health care, making it more difficult for millions of Pennsylvanians,” said Secretary Miller. “Medicaid, Medicare, and the Affordable Care Act are lifelines, and the federal government must recognize the important role they play in many lives and strengthen these programs so they may continue to help people live healthy, productive lives for years to come.”

MEDIA CONTACT:   Ali Fogarty – 717.425.7606
Ron Ruman, PID – 717.787.3289
Drew Wilburne, Aging – 717.705.3702

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RCPA will be monitoring the federal budget in conjunction with our national associations and will inform members about any important updates. Further questions may be directed to Jack Phillips.

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Department of Drug and Alcohol Programs: Wolf administration holds regional summit on warm hand-offs for opioid overdose survivors.

Text of March 20 press release.

Summits bring together stakeholders to strengthen direct pathway to treatment for opioid overdose survivors.

Ivyland, PA – As Governor Tom Wolf today signed the sixth renewal of his opioid disaster declaration, officials from his administration kicked off a series of regional summits to address warm hand-offs for opioid overdose survivors. The event was held at Spring Hill – The Manor in Ivyland, Bucks County.

The summits bring together stakeholders from state and local governments, the drug and alcohol treatment landscape, and health systems to address best practices and implementation roadblocks in providing a warm hand-off to patients treated for an opioid overdose. Eight summits will take place at locations across the state during March and April.

“Over the past year thousands of lives have been saved through warm hand-off programs,” said Department of Drug and Alcohol Programs Secretary Jennifer Smith. “We know this is a key component in strengthening the drug and alcohol landscape throughout Pennsylvania. These summits are designed to fully equip counties who may be struggling to implement their programs with the tools and knowledge to have successful warm hand-off programs. In turn, helping to save our neighbors and loved ones.”

Today, warm hand-off programs at various levels of implementation exist around the commonwealth. Since January 2017, more than 5,000 individuals have been directly referred to treatment as part of the warm hand-off concept. Counties with successful implementations are seeing a success rate of 90 percent of overdose survivors directly admitted into drug and alcohol treatment following an overdose.

“Once we revive someone who has overdosed with naloxone, it is essential that we get those people into treatment,” Secretary of Health Dr. Rachel Levine said. “Warm handoff programs allow our medical providers and our drug treatment providers to ensure that someone with the disease of addiction gets the help they need. Treatment works and recovery is possible for those battling substance use disorder.”

In February 2017, the Department of Drug and Alcohol Programs (DDAP), Department of Health, and Pennsylvania chapter of the College of Emergency Physicians released a clinical pathway designed to create an easy transition from care for an opioid overdose to treatment for an opioid use disorder. As part of an update in the 2015–2020 grant agreement between DDAP and local Single County Authorities (SCA), SCAs are now required to establish a warm hand-off policy locally.

Representatives from the departments of Drug and Alcohol Programs, Health, Human Services, and Insurance will participate in each of the eight summits:

  • Philadelphia (March 21)
  • Johnstown (March 27)
  • Pittsburgh (March 28)
  • York (April 4)
  • Wilkes-Barre (April 11)
  • Williamsport (April 16)
  • Erie (April 17)

For more information about the warm hand-off summits and the clinical pathway, visit ddap.pa.gov

Media contact: Rachel Kostelac, 717.547.3314

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Further questions may be directed to Jack Phillips

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CALLING ALL GOLFERS!

It’s time to register for RCPA PAC’s 6th annual golf outing at the beautiful Hershey Country Club, 1000 East Derry Road, Hershey, PA 17033 on Thursday, May 9! Registration starts at 10:30 am, lunch begins at 11:00 am, followed by a putting contest and 12:30 pm shotgun start.

Golf outing sponsorships are also available. We hope you will consider becoming a golf sponsor. It is a great way for your organization to get noticed and an opportunity to support a worthwhile cause.

The RCPA PAC raises money and supports campaigns of state legislators who work tirelessly on issues that benefit mental health, intellectual disabilities, children’ services, substance use disorder treatment and services, brain injuries, medical and vocational rehabilitation, physical disabilities and aging, and other related human services. The funds raised through RCPA PAC can make the difference between a win and a loss on an issue or assist in making a new ally. Even if you can’t be a strong contributor to RCPA PAC fundraising efforts, we all have friends and business associates who are interested in helping our allies to victory. Getting involved in RCPA PAC not only allows you to help make decisions on who the committee supports, but also helps to identify new folks who will join in our successes. Further questions may be directed to Jack Phillips, RCPA Director of Government Affairs.

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Recently, the Federal Department of Labor (DOL) announced its new proposed overtime rule. The DOL is proposing to raise the overtime threshold from the current level of $23,600 ($455/week) up to $35,308 ($679/week).

In 2016, President Obama’s overtime proposal would have taken the threshold to $47,476 ($913/week), and Governor Wolf’s 2018 proposal would take it to $47,892 ($921/week). Unlike previous proposals, the rule is not expected to include an automatic escalator.

More information about the proposed rule is available online. The DOL encourages any interested members of the public to submit comments about the proposed rule electronically at this website, in the rulemaking docket RIN 1235-AA20. Once the rule is published in the Federal Register, the public will have 60 days to submit comments for those comments to be considered.

Questions, please contact Jack Phillips, Director of Government Affairs.

The Coalition to Preserve Behavioral HealthChoices, which includes RCPA, has signed onto a letter that will be sent out to members of the General Assembly stating “strong opposition to House Bill 335.” This bill calls for elimination of the Behavioral Health Carve-Out, known as Behavioral HealthChoices (BHC). BHC is the statewide program through which every county delivers mental health and drug & alcohol services to vulnerable Pennsylvanians enrolled in the Medical Assistance program, and their families. Please contact RCPA Director of Government Affairs Jack Phillips with any questions.

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Yesterday, after Governor Wolf delivered his 2019/20 budget address to the General Assembly, the Department of Health (DOH) and the Department of Human Services (DHS) held a budget briefing updating stakeholders on the status of 2018/19 initiatives and rolling out the Governor’s 2019/20 DOH/DHS budget initiatives. The Governor’s main initiatives for DOH and DHS for the upcoming fiscal year are as follows:

  • Increase the minimum wage;
  • Help low-income working parents support their families;
  • Strengthen high quality care for infants and toddlers;
  • Expand evidence-based home visiting;
  • Expand services for individuals with intellectual disabilities and autism on the waiting list;
  • Protect individuals in personal care homes and residential and day-treatment programs;
  • Support Pennsylvanians with disabilities;
  • Invest in mental health services; and
  • Combat the opioid epidemic.

For further information on the above initiatives, please see the DOH and DHS PowerPoint presentations. Questions, contact RCPA Director of Government Affairs Jack Phillips.

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Today, Governor Wolf delivered his 2019/20 budget address in front of the Pennsylvania General Assembly. The Governor’s budget address talked primarily about workforce and education. Specifically, the Governor is not proposing any new tax increases; rather he is focusing on investments in workforce, education, and continuing the fight against opioid abuse.

The Governor’s proposed budget expands access to early childhood education, increases investments in schools, and partners with the private sector to build on the PAsmart initiative, launched last year as a groundbreaking approach to workforce development.

The following are highlights from the Governor’s budget address:

Keystone Economic Development and Workforce Command Center
Tackling the skills gap and creating a well-trained workforce requires government, schools, and industry to work together. PAsmart was the first step, but Governor Wolf wants bolder action. Soon the governor will sign an executive order creating the Keystone Economic Development and Workforce Command Center. The departments of Community and Economic Development, Labor & Industry, State, and others will partner with external leaders to find solutions that will strengthen our workforce.

“Across the commonwealth, we have workers aging out of our workforce, and too often the next generation of worker is not there or doesn’t have the skills to replace them,” said Governor Wolf. “If we can’t strengthen our workforce, we will fall behind. And we cannot let our government’s response to this problem be handcuffed by stale habit. The time is now for this comprehensive plan for preparing Pennsylvanians to compete and win in our rapidly changing economy.”

Early Childhood Development and Parent Support
Parents cannot work if they lack food, housing, or childcare. To break the cycle of poverty, the governor’s budget invests in early childhood education and removes barriers for low-income parents. The proposal provides $5 million to expand home-visiting programs for pregnant women and at-risk infants and toddlers, $15 million in federal funds to reduce waiting lists for high-quality childcare, and $5 million for wrap-around services so parents can attend college or other training to get skills for family-sustaining jobs.

Continuing Investments in Education and Career Training
The governor’s budget ensures that every student is ready for a career by continuing investments to improve public schools along with more funding for early childhood programs, K-through-12, and higher education. The budget provides increases of $200 million for basic education, $50 million for Pre-K and Head Start, $50 million for special education, $7 million for the Pennsylvania State System of Higher Education, and $8 million in one-time grants for community college students or graduates who are working in Pennsylvania.

PAsmart is an innovative and pioneering approach to connecting Pennsylvanians with education and training opportunities, apprenticeships, and STEM careers, and the governor’s budget expands this initiative with an additional $4 million to help Pennsylvania manufacturers train workers and $6 million to expand career and technical education for adults.

Governor Wolf is also proposing to save nearly $120 million over the next two years by raising Pennsylvania’s minimum wage to $12 an hour on July 1, 2019. The boost in pay for one million workers would enable tens of thousands of people to work their way off of public assistance, reducing the burden on taxpayers who are subsidizing low wages.

To prevent students from falling behind, the governor’s plan lowers the age when students must start attending school from 8 to 6 and increases the dropout age from 17 to 18. The administration will also study the benefits of providing free full day kindergarten to all children starting at age 5.

Contact RCPA Director of Government Affairs Jack Phillips with any questions.