';
CLOSE
Uncategorized

0 1172

In the years Pennsylvania has been earnestly battling the opioid overdose death epidemic, many ideas have been suggested or implemented for intervening with overdose survivors. From hard line proposals (go to treatment following an overdose reversal or face criminal charges) to logistically complex processes (embed peers in emergency rooms to facilitate the transfer of overdose survivors to a treatment facility), these strategies have yielded mixed results as judged against one grim fact: exacerbated by Covid, 5,063 Pennsylvanians died of a drug overdose in 2020 (the latest year for which overdose death totals are confirmed). That total is second only to the record set in 2017, with 5,403.

One of the newest initiatives to intervene with overdose survivors is currently under way in Pittsburgh. By addressing many of the shortcomings of other intervention efforts, this strategy employs an evidence-based harm-reduction approach.

In Pittsburgh, Emergency Medical Services (EMS) is eliminating barriers to treatment and connecting patients to recovery resources through its prehospital buprenorphine program, a Pennsylvania Department of Health-approved pilot program that complies with all state and federal laws and regulations. Joshua Schneider, an emergency medical technician and overdose prevention coordinator for the City of Pittsburgh, recently testified before the Center for Rural Pennsylvania about the program, which allows paramedics to administer buprenorphine to a patient experiencing opioid withdrawal, whether part of an overdose reversal or not, and connect that patient directly to a telemedicine clinic. The patient then can receive a buprenorphine prescription, typically within 24 hours. This program circumvents traditional barriers, because it offers medication at the point of EMS engagement, does not require transport to an emergency department, and offers low-threshold access to ongoing treatment through a simple phone call. To date, this pilot program has improved post-overdose withdrawal symptoms for all enrolled patients and has resulted in multiple patients continuing treatment.

EMS providers respond to a high number of opioid overdose calls and are a key access point to the health care system for people who use drugs. A large number of patients who engage with EMS following an overdose decline transport to the hospital, creating an access gap that leaves patients without any care beyond resuscitation with naloxone. In 2021, more than 30 percent of Pittsburgh EMS patients declined transport to the hospital after experiencing an opioid overdose, approximately double the transport refusal rate for other call types. While an emergency department is not always the optimal place for a person who has overdosed to receive care, it can act as a resource hub where patients can be connected to substance use treatment and social services. Patients who decline transport to the hospital cannot be connected to those resources. The majority of EMS agencies lack the ability to connect patients to other forms of care and patients who are not transported to the emergency department are often left at the scene with nothing more than a box of naloxone or a resource pamphlet.

Even patients who accept transport to the emergency department struggle to get connected with substance use treatment. While all Allegheny County emergency departments have the ability to administer buprenorphine and make a referral to community providers, most patients who present to the emergency department do not receive buprenorphine or linkage to longitudinal care.

Effective treatment, including medication, for opioid use disorder (OUD) exists today beyond what has been traditionally viewed as rehabilitation. For those individuals willing to accept buprenorphine treatment as a potential pathway to recovery from OUD, Pittsburgh’s prehospital buprenorphine program offers great promise.

0 1162

Frustrations mount as many retail pharmacies struggle to meet the needs of the providers they work with and the consumers they serve.

Fluctuating hours, long lines, and cancelled appointments are just some of the barriers consumers face, while providers encounter lapses in communication with vital partners in patient care.

A New York Times article recently detailed the retail pharmacy crisis driven by both staffing shortages and increased demand. Because many consumers are struggling to get the medications they need, providers have adjusted their prescribing methods – filling a 90-day supply for what used to be a 30-day supply, for example – to ensure their consumers can stay on track.

Amid this crisis, clinics who partner with Genoa Healthcare® are finding even more benefit in having a reliable on-site pharmacy team. When a local pharmacy chain closed their doors in Oregon, nearby retail chains became flooded with prescriptions to fill in the community. People trying to get their medications were met with long wait times and miscommunication from pharmacy teams they had never met.

Understanding the challenges in her community, Genoa Pharmacist Shuga Knopp reminded her partners at the clinic that her team could fill all the medications consumers and staff needed.

“I wanted them to know that they wouldn’t have trouble getting their medications from my team at Genoa,” Knopp said. “We’re consistent and we care.”

Knopp and her team continue to develop personal relationships with their consumers, ensuring they can provide the best support for their medication needs.

“People were more frustrated with their pharmacies than they had ever been, and their pain points felt preventable,” Knopp said. “They’re just so happy that they can count on us, and that we actually answer the phone when they call.”

As demand for behavioral health care continues to increase, Genoa pharmacy teams also lighten the burden for their partners’ staff by assisting with prior authorizations, taking on medication-related challenges, and being a resource for consumers in between their appointments. These services result in a more integrated care team and better outcomes for consumers.

Do you have questions or challenges pertaining to the current retail pharmacy crisis? Contact me.

0 872

Almost half of the states are operating Medicaid managed long-term services and supports (MLTSS) programs, but there has historically been limited evidence of their value. To help fill this gap, this report presents updated results from states responding to ADvancing States’ survey, as well as new research on states with MLTSS programs. The 12 states responding to the surveys — Arizona, Florida, Iowa, Kansas, Massachusetts, Minnesota, New Jersey, New Mexico, Tennessee, Texas, Virginia, and Wisconsin — account for more than half of the states who are operating MLTSS programs. States were asked about their goals in implementing MLTSS programs, what progress they had made in attaining those goals, and if they faced any challenges collecting data to document progress. In addition, new research has documented additional value from MLTSS programs in the following areas:

  • Rebalancing Medicaid LTSS Spending. Rebalancing Medicaid long-term services and supports spending toward home- and community-based settings and providing more options for people to live in and receive services in the community was a key goal for all states. Many states have specific rebalancing targets, as well as financial incentives for MLTSS plans to meet them.
  • Improving Member Experience, Quality of Life, and Health Outcomes. All states wanted to improve consumer health and satisfaction/quality of life. While it can be challenging to attribute improvements in health outcomes solely to MLTSS programs, seven states reported improved consumer health. Eleven states said that they collect data on the quality of life; from those reporting outcomes, MLTSS consumers had improved quality of life and high levels of satisfaction compared to fee-for-service programs. One challenge highlighted by states was that the fielding the surveys used to collect these data is time and labor-intensive.
  • Reducing Waiver Waiting Lists and Increasing Access to Services. MLTSS programs may reduce or eliminate waiting lists for waiver services. Seven states said they wanted to reduce waiting lists, while others focused on increasing access to services. Some states successfully eliminated waiting lists, while other states addressed waiting lists through prioritizing applicants by level of need. Some states reinvested savings achieved through implementing MLTSS to decrease the number of people on waiting lists.
  • Increasing Budget Predictability and Managing Costs. MLTSS programs’ use of capitated payments can help improve budget predictability. The programs also have the potential to achieve savings by: rebalancing LTSS spending, managing service use, and avoiding unnecessary hospitalizations or institutional placements. While states report they are “bending the cost curve,” inadequate data are a barrier to states’ ability to demonstrate these outcomes. The state surveys and recent research provide compelling examples demonstrating that states are meeting their MLTSS program goals. It also underscores the importance of expanding the scope and amount of data collected on program impacts. Health plan contracts with strong data reporting and performance monitoring requirements are important tools for states to build stakeholder support and demonstrate program viability over time.

0 725
Photo by Mikael Blomkvist from Pexels

About 73% of the American “Baby Boomer Generation” (between the ages of 57 and 75) hope to receive long-term care (LTC) in their current home. Another 17% want to receive LTC in an assisted living facility, and 2% would prefer to receive LTC in a nursing facility.

About 47% of non-retired Americans and 33% of retired Americans say they are concerned that it will not be safe for them to remain in their home when they need LTC. As a result, only 56% of Baby Boomers believe that their home is the most likely place for them to receive LTC, 23% believe receiving LTC in an assisted living facility is most likely, and 6% believe they are most likely to need nursing home care.

A full 50% of adult Americans feel it is the responsibility of their family to care for them if they need LTC; this equates to 69% of Millennials, 52% of those in Generation X, and 33% of Baby Boomers. About 70% of adult Americans would like to have the option of relying on a family member if they need LTC; however, 70% also would not expect a family member to provide LTC without compensation. A total of 66% are worried that they will become a burden to their family as they get older.

More than half of respondents consider themselves at least somewhat knowledgeable about the options available in LTC. For Baby Boomers, approximately 49% said they were very or somewhat knowledgeable about their options. About 63% of Millennials said they were very or somewhat knowledgeable about their options, and 55% of those in Generation X said they are familiar with their options.

More than 60% of respondents said they were uncertain about costs related to specific LTC options. When asked about the costs for assisted living communities, 63% of Baby Boomers said they were unsure about annual costs, compared with 61% of those in Generation X and 59% of Millennials.

In 2020, the estimated annual median costs of US assisted living communities was $51,600. When asked what they thought this number was, Baby Boomers estimated the cost to be $65,000. Those in Generation X estimated this cost to be $41,379; and Millennials estimated the cost to be $23,467.

About 88% of Americans believe it’s very important for people to have a plan for LTC insurance. A total of 86% said that it is very important to have LTC insurance. However just 25% of those surveyed said they currently own LTC insurance for themselves. Millennials (39%) are more likely than those in Generation X (26%) and those of Baby Boomer age or older (19%) to claim they currently own LTC insurance for themselves.

These findings were presented in the 2021 Nationwide Long-Term Care Consumer Survey, conducted by The Harris Poll for The Nationwide Retirement Institute® in October 2021. Researchers at The Harris Poll surveyed 1,812 US adults aged 24 or over, and 706 caregivers. The goal was to determine trends in consumer opinions, expectations, and planning related to long-term care.

The full text of the 2021 Long-Term Care Consumer Survey results was published December 8, 2021, by Nationwide.

0 2202

ODP Announcement 21-091 provides notice that the Federal Supplemental Security Income (SSI) payment will increase beginning January 2022. Effective January 2022, the SSA increased the SSI allotment by 5.9 percent to reflect an increase in the cost of living. This raises the maximum monthly income to $841 for an eligible individual, $1,261 for an eligible individual with an eligible spouse, and $421 for an essential person. There is no anticipated increase in the State Supplementary Payment (SSP) for 2022.

To account for the new COLA, Room and Board contracts should be reviewed to determine appropriate adjustment for those living in homes operated by Residential Habilitation or Life Sharing providers who collect room and board fees from individuals enrolled in the Consolidated, Community Living, and Adult Autism Waivers and providers of base-funded residential habilitation and life sharing services.

SSI is a federal program that provides benefits to adults and children who meet the SSA’s requirements for disability, income, and resources. This income benefit is designed to help qualified individuals meet basic needs for food, clothing, and shelter. Periodically, a COLA affects the maximum monthly allotment.

The Room and Board Contract (DP 1051) is found on MyODP.org at the following path: Resources > Intellectual Disability > Forms. Office of Developmental Programs. Beginning July 1, 2020, the requirements for Room and Board as established in 55 Pa. Code Chapter 6100 must be followed.

ODP is in the process of replacing the DP 1051 form to reflect Sections §§6100.681–6100.694 that providers will begin to use. The current DP 1051 will continue to be accepted as current until the annual due date or until a change requires that a new form is completed.

ODP will be releasing a bulletin to stakeholders regarding the new room and board requirements with the 6100 regulations. This bulletin will also inform stakeholders of the new form and where it can be found on myodp.org.

0 795

Throughout 2021, RCPA’s top priority for its drug and alcohol treatment provider members has been the ASAM transition. Most specifically, RCPA has been working against requirements the Department of Drug and Alcohol Programs (DDAP) is imposing on providers that go beyond ASAM Criteria. Although RCPA members support the ASAM Criteria as a placement, continued stay and discharge tool, changes to intensive outpatient counselor-to-client ratio, required daily therapeutic hours at the residential level of care, and credentialing requirements all constitute unlawful rulemaking. In other words, DDAP and the Department of Human Services (DHS) have circumvented the regulatory review process in creating requirements that should have been put before the Independent Regulatory Review Commission (IRRC). DDAP’s and DHS’s failure to do so means that costs to implement and stakeholder input, among other considerations, were ignored.

In the months-long effort to reach a more manageable transition for providers, December is shaping up to be a decisive month. On Oct. 28, Commonwealth Court heard a request for a preliminary injunction filed by the Drug and Alcohol Service Providers Organization of Pennsylvania (DASPOP) that would stop implementation of the overreaching requirements. In its defense, DDAP asserted that the requirements in question are not requirements at all but actually guidelines that are not subject to IRRC approval. Yet with DDAP in the lead, these “guidelines” have been placed in provider contracts with single county authorities (SCAs) and behavioral health managed care organizations, and deadlines for compliance with them have been set by DDAP. Ultimately, the court will decide whether the actions of DDAP and DHS have created binding norms using the Medicaid managed care system as a workaround to the lawful regulatory review process. As of this writing, Commonwealth Court still had not made a decision.

On a parallel track, House Bill 1995 is making its way through the legislature. Rep. Carrie Lewis DelRosso introduced legislation that would require DDAP to undergo the regulatory review process any time it makes changes that would affect licensed drug and alcohol providers, including changes such as the requirements DDAP is imposing as part of the ASASM transition. DDAP’s overreach on the ASAM transition was the impetus for Rep. Lewis DelRosso’s bill. Despite facing strong opposition from the administration and the SCAs, the bill passed out of the House of Representatives into the Senate, which is expected to consider the bill when it is back in session Dec. 13 – Dec. 15.

The timing of decisions related to DASPOP’s lawsuit and Rep. Lewis DelRosso’s legislation is made all the more critical by the expiration of the ASAM alignment extension, which the legislature allowed for earlier this year. Through Act 70, the legislature created a process whereby providers could apply for an ASAM alignment extension to Jan. 1, 2022. Providers that applied for and were granted the extension do not have to align with DDAP’s requirements on ratio, daily therapeutic hours, and credentialing until Jan. 1.

These overreaching mandates come at a time when addiction treatment providers are struggling with an unprecedented workforce shortage. Any mandates that force the hiring of additional staff only exacerbate the issue and narrow access to treatment. In addition, the treatment system continues to reel from the Covid pandemic and the ongoing fallout from it. By imposing these requirements on a chronically underfunded system, DDAP and DHS are further weakening a system so desperately needed by so many Pennsylvanians. With more than 100,000 Americans having died from drug overdose in the 12 months ending April 2021, the administration’s unlawful actions have the real possibility of contributing to, rather than lowering, this shameful record.

Prev1...234...7Next Page 3 of 7
© 2021 - Rehabilitation & Community Providers Association