Two of the most significant public health crises of our lifetime – the Covid pandemic and the opioid overdose death epidemic – have hit the addiction treatment system and the patients it serves especially hard. Add to a chronically underfunded system struggling with an alarming workforce shortage the Pennsylvania Department of Drug and Alcohol Programs’ (DDAP) ill-timed transition to the American Society of Addiction Medicine (ASAM) Criteria that includes unfunded mandate add-ons, and the very integrity of the system is at risk. Fortunately, the federal government has stepped in with resources to combat the epidemic and the pandemic. In fact, by this fall, DDAP will have received just this year more than $100 million in special grant money, including $55 million in Covid supplemental funds and $48 million in American Rescue Plan (ARP) dollars. Now, perhaps more than ever, addiction treatment providers desperately need this money. Unfortunately, none of it has made its way to providers yet.
Despite urgent pleas for help – by way of either rate increases, regulatory relief, or other one-time funding infusions to address multiple short-term crises within the system – the Wolf administration has not operated with urgency. Consider that in early June, the Substance Abuse and Mental Health Services Administration (SAMHSA) approved DDAP’s plan to spend the $55 million in Covid supplemental money. Nearly two months later, the most-needed chunks of those dollars — $10 million in provider stabilization payments and $15 million in workforce development funding – have not made their way to providers. The $10 million in provider stabilization funds is expected to be available to providers in October, more than four months after their approval. There is no estimate on when the $15 million in workforce development dollars will be available.
Providers recognize that this $25 million across a system comprised of approximately 800 licensed facilities is no panacea. But what message is being sent when providers continually stress to DDAP the real possibility of program closures because of burdensome mandates, no counselors, and insufficient reimbursement rates while money sits unused? There is a disconnect between the front lines and the regulators.
Then there is the $48 million in ARP money. It is supposed to be available to DDAP by the fall, at which point it’s entirely possible that the department will be sitting on more than $100 million (not to mention the $5 million annually for the next five years from the McKinsey opioid settlement) with none or very little having reached the providers.
Although the governor had sought to extend his latest opioid disaster declaration beyond August 26, now that his ability to do so unilaterally has been limited to 21 days, the legislature said “no.” While on the surface this would seem problematic for the D&A treatment community, this may not be the case. When RCPA informally polled its provider members on what the end of the opioid disaster declaration would mean, none who responded could identify any practical or operational benefit of the declaration. Those things they did mention – broader access to naloxone, for example – are not tied to the declaration. Thus, while well intended, from a day-to-day standpoint for D&A treatment and access to services, there are many other ways that the administration and the legislature could greatly assist without necessitating a further extended emergency declaration.
The provider system needs meaningful help, including a more transparent, effective reimbursement rate-setting process and relief from burdensome mandates that create barriers to effective treatment. We have demonstrated repeatedly that the very thing DDAP purports to seek through its mandates – improved quality – will actually be negatively affected, because providers cannot find staff to meet these new mandates or afford to pay them, in part, as a result of a vastly changed pandemic job market. Ultimately, access to treatment will be limited, and Pennsylvania’s most vulnerable citizens will continue to be the collateral. The fact that funding meant to ease these real burdens has not reached the providers yet is salt in the wound. RCPA will continue its work educating the legislature on the tenuous situation in an effort to get the help that we need.