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Govt. Affairs

RCPA received the following email from the Senate Aging Committee in Washington, DC. Please contact both Senators Casey and Toomey and your Congressman.

“Welcome back to health care by way of a tax bill.

This afternoon both the Senate and the House added to their tax bills a provision to repeal a key component of the Patient Protection and Affordable Care Act, the individual mandate to obtain health insurance. Repealing this provision would have significant negative effects for people with disabilities, families of children with disabilities, and those who are aging.

  • Repealing the individual mandate will mean 13.8 million people will lose health care coverage (according to an analysis by the Congressional Budget Office); hundreds of thousands of those individuals have disabilities).
  • The repeal of the individual mandate will increase health insurance premiums for those purchasing coverage on the exchange by at least 10% per year for the unforeseeable future (also according to an analysis by the Congressional Budget Office); these premium increases will occur in addition to the increases that are occurring because the executive branch has decided to stop supporting cost sharing reduction (CSR) payments that have driven premiums up by an average of over 20% this year.
  • The repeal of the individual mandate will save approximately $330 billion over ten years that will go toward paying for a cut in corporate taxes and a cut to the tax rate for the most wealthy Americans (according to the CBO).

This new, last minute, major addition to the tax bills will have enormous impact on those with disabilities. In combination with the budget that passed three weeks ago and outlines over $1 trillion in cuts to Medicaid and over $400 billion in cuts to Medicare, the proposed tax cuts and repeal of key provisions of the ACA will increase demand for Medicaid, decrease the funds available for home and community-based services and supports, and reduce the amount of revenue available to states to pay and support Medicaid.

While the tax bill does not directly cut Medicaid, the actions it takes will have the same or even worse effect on Medicaid and other services and supports for people with disabilities. If the House tax bill were to pass:

  • Deductions for medical expenses could not be used to decrease your taxes;
  • It would eliminate a $2,400 tax credit businesses could get when hiring someone with a disability;
  • It would eliminate a $5,000 tax credit for businesses that make their businesses accessible to people with disabilities;
  • It would eliminate the incentive to contribute to nonprofit agencies that often provide support for people with disabilities and their families; and
  • It would remove a tax credit for companies to develop and manufacture orphan drugs.

The assault on people with disabilities and their families is continuing, this time through a tax bill instead of through a health bill. And this is happening quickly with very little coverage. The Senate Finance Committee will likely vote on this bill Thursday or Friday of THIS week.

You can help by:

  • Contacting your Senators and Representatives and telling them the tax bills being considered are an attack on people with disabilities; and
  • Share this information with friends and family.

Thank you for your continued advocacy. Thank you for working to ensure dignity, independence, and economic sufficiency for people with disabilities.”

Questions, contact Jack Phillips, RCPA Director, Government Affairs.

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Today, the Senate Health and Human Services Committee unanimously passed HB 478, the Outpatient Psychiatric Oversight Act. The bill now moves to the Senate floor. As background, RCPA and its members have been working on getting the Department of Health and Human Services (DHS) to move the outpatient psychiatric regulations, which have been promulgated for more than three years.

Over the past few months, DHS has taken steps to move the outpatient regulations towards completion. RCPA supports DHS’ efforts to move this package of regulations; however, because of the length of time it has taken to move the regulations, certain provisions contained within the regulation package are antiquated or need to be updated to current outpatient service delivery standards.

Specifically, the psychiatric recruitment crisis has grown exponentially, especially in rural areas. By introducing HB 478, Rep. Pickett (R–Bradford, Sullivan, and Susquehanna Counties), the prime sponsor of the bill, has taken legislative action to update sections within the outpatient psychiatric regulation package to current outpatient service delivery standards, and to start implementing these updates immediately through this legislation.

In short, HB 478 provides that:

  • An outpatient psychiatric clinic needs to have a psychiatrist on site for two hours of psychiatric time per week for each full-time equivalent treatment staff member employed by the clinic;
  • Tele-psychiatry can be utilized by a psychiatrist, who has prescriptive authority in Pennsylvania and is not on site. The Department of Human Services will have to approve a service description;
  • 50 percent of the required on-site time may be provided by other advanced practice professionals specializing in behavioral health with prescriptive authority in Pennsylvania; and
  • The Department of Human Services will promulgate regulations as necessary to carry out the provisions of the act.

RCPA believes that Rep. Pickett’s bill, HB 478, will allow psychiatrists to see more clients in a timely fashion and ultimately increase access to psychiatric services, which is vital due to the shortage of psychiatrists in the Commonwealth.

As the bill moves through the process, RCPA will keep members informed. Contact Jack Phillips, RCPA Director of Government Affairs, with any questions.

Executive Order to Review State Licensure Board Requirements & Processes

In the November 11, 2017 Pennsylvania Bulletin, Governor Wolf issued an Executive Order (No. 2017-03) that directs the Commissioner of Professional and Occupational Affairs within the Department of State to conduct a review of the State Professional and Occupational Licensure board requirements and processes. This includes a comprehensive review of the processes, fees, training, and continuing education requirements and prepared report for each type of professional and occupational license. The report is to include: training requirements; licensing, registration, and renewal fees; continuing education requirements; and any other requirements described within the executive order. The report is to also include information regarding the number of other states which require a license for each professional or occupational license, the national and regional averages for training requirements, fees, and continuing education requirements.

The Commissioner has been given the authority to establish an advisory group to assist with the research, data collection, and formatting of the reports, and any other function the Commissioner deems necessary. The advisory group shall be composed of members chosen by the Commissioner from the professional Boards and Commissions, Bureau of Professional and Occupational Affairs (BPOA) staff, and any other persons the Commissioner deems necessary. The advisory group must be established within 30 days from the effective date of this executive order. Additional details regarding the report are provided in the bulletin.

The report is due to the Governor, the Secretary of Policy and Planning, and the Secretary of the Commonwealth no later than 180 days from the establishment of the advisory group or 210 days from the effective date of this executive order, whichever is sooner.

Some of the boards impacted by this executive order include: State Board of Physical Therapy, State Board of Speech–Language Pathology and Audiology, the State Board of Medicine, the State Board of Nursing, the State Board of Occupational Therapy, etc.

The executive order is effective immediately.

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From: DHS STAKEHOLDERS – On Behalf Of HS, Secretary’s Office
Sent: Monday, November 06, 2017 12:00 PM
Subject: [DHS-STAKEHOLDERS] Community HealthChoices Update

The Wolf Administration is committed to providing access to high-quality services to all Pennsylvanians and to serving more people in the community.

Community HealthChoices (CHC) is the commonwealth’s program for older Pennsylvanians and individuals with physical disabilities to use health plans to provide coordinated physical health care and long-term services and supports. The goals of CHC are to improve quality of services and the health care experience – serving more people in their communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.

CHC is being implemented in three phases. For Phase 1, notices have been mailed to participants in the 14 counties in the Southwest Zone to inform them that they will move to CHC on January 1, 2018. Participants are currently learning more about CHC through community meetings and the independent enrollment broker. Phase 1 is expected to include approximately 80,000 people.

CHC is about choice – choice in where a person wants to live and choice in who will provide the care needed to make that a reality. Even though the deadline for Phase 1 participants to select a managed care organization (MCO) is not until November 13, 2017, more than 21,500 people have already made an active choice by already selecting their health plan and their primary care provider.

Recognizing how critical these services are, we are focused on getting this right – the health care coverage for 420,000 Pennsylvanians depends on it.

We are confident that the southwest is ready for Phase 1, but in order to allow for the deliberate and purposeful implementation of CHC in the southeast region (Phase 2) and the remainder of the state (Phase 3) we need to have the flexibility of learning from that roll out with proper time to make any needed adjustments.

Given this, the commonwealth has decided to shift the implementation dates for the next two phases of CHC. The new start dates are as follows:

  • Phase 2 will now begin on January 1, 2019, instead of July 1, 2018
  • Phase 3 will now begin on January 1, 2020, instead of January 1, 2019

chc-rollout-map

These new dates will allow us to provide Pennsylvanians eligible for CHC with a health plan that will give them better access to health care. Our commitment to CHC is unwavering and we look forward to continuing to work with you in preparation for January 2018’s Phase 1 rollout.

Regards,
Teresa Miller
Department of Human Services, Acting Secretary

Teresa Osborne
Department of Aging, Secretary

Overdose deaths from heroin and prescription drug abuse pose a public health crisis. In 2016, 4,642 drug-related overdose deaths were reported in Pennsylvania – an increase of 37 percent from 2015 – and every day 13 Pennsylvanians die of a drug overdose.

Yesterday, President Trump officially declared the opioid crisis a public health emergency. This declaration will allow states to redirect federal funds to the opioid crisis. However, it provides no new federal funding. RCPA was pleased to learn that President Trump proposed relaxing the Institutions of Mental Diseases (IMD) exclusion for inpatient substance use disorder treatment. The IMD exclusion, which bars Medicaid payment for services delivered in certain facilities with 16 or more beds, has been a major barrier against patients accessing treatment. Pennsylvania officials have stated on numerous occasions that they clearly understand the severity of the IMD exclusion and are working on numerous ways to resolve the problem. Trump’s announcement will likely make that easier to accomplish. This announcement may also allow for expanded access to telemedicine, including remote prescribing for medication-assisted treatment.

Governor Wolf stated that “President Trump’s decision to declare the opioid epidemic a public health emergency is an important step, but this is only the beginning.” He added that “Without a commitment to fund the crisis in specific ways, it’s difficult to say how much this declaration can do. While an awareness of this critical health emergency is important, an increased availability of grant money would help. Every effort to fund treatment, including medication-assisted treatment options, should be explored.”

Pennsylvania has numerous efforts underway to respond to this crisis. Governor Tom Wolf announced at the end of September that Pennsylvania, through its Department of Drug and Alcohol Programs (DDAP), had been awarded a $5.7 million Medication-Assisted Treatment Prescription Drug and Opioid Addiction (MAT-PDOA) grant from the US Department of Health and Human Services, to help in the state’s ongoing fight against the opioid epidemic. The US Department of Health and Human Services also awarded Pennsylvania a $26.5 million grant, funded by the 21st Century Cures Act, signed into law by President Obama in December 2016. Pennsylvania will soon award four $1 million federal PA Coordinated MAT grants to providers in Pennsylvania, via the 21st Century CURES grant funding. Over the next two years, the grant is intended to help combat the heroin and opioid epidemic. In addition, 45 Centers of Excellence (COE) have been implemented to better initiate people into — and keep them engaged in — treatment. DDAP is also working to expand the “warm handoff” process to get overdose survivors directly into treatment. DDAP has implemented a hotline to direct people needing help with treatment (800-662-HELP).

RCPA members have welcomed these initiatives, but members continue to emphasize the need for more funding for basic services. Many rates provided do not even cover the full cost of treatment; the drug and alcohol program has been chronically underfunded for many years. Increased capacity and improved access must be fully funded and that will take new and additional resources. Persons and families struggling for help with an opioid addiction should not have to wait for beds/placements — it is a matter of life or death.

Contact Lynn Cooper, RCPA Director, Drug & Alcohol Division, with any questions.

On October 26, 2017, the Energy & Commerce Committee and the Ways and Means Committee announced in a press release that they have come to a policy agreement on a permanent repeal of the Medicare therapy caps. The policy/discussion draft will repeal the therapy caps, continue to require an appropriate modifier is included on claims submitted over the new threshold (indicating the services are medically necessary), and continue targeted medical review of claims established by the Medicare Access and CHIP Reauthorization Act (MACRA).

Background:
In 2006, Congress created an exceptions process allowing patients to exceed the cap based on medical necessity. The cap was addressed most recently in 2015 with MACRA (H.R. 2), becoming law. A provision in H.R. 2 established targeted medical review of therapy caps and extended the therapy cap exceptions process until January 1, 2018.

As the implementation of Community HealthChoices (CHC) approaches the January 1, 2018 launch in the Southwest Region, the Department of Human Services (DHS) has developed informational materials for those individuals who will be covered by the new program. The documents, including notices and the pre-enrollment packet, are posted on the DHS website, where you will also find their most recent participant document, “CHC: Here’s What You Need to Know” (available for download in English and Spanish).

In addition, a document designed to clarify eligibility for CHC is available here. It includes the following information:

Individuals are NOT eligible for CHC if they are a person with an intellectual or developmental disability who is eligible for services through the Department of Human Services’ Office of Developmental Programs (ODP), OR are a resident in a state-operated nursing facility, including state veterans homes.

Please visit the CHC website or call the CHC Provider Hotline at 833-735-4417 with any questions.

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Pennsylvania Acting Secretary of Human Services Teresa Miller announced the following three staffing changes within the Department of Human Services (DHS):

  • Executive Deputy Secretary. Leesa Allen, currently DHS’ Deputy Secretary for Medical Assistance Programs, will be moving into the Executive Deputy Secretary position. Ms. Allen has more than 23 years of experience in the Commonwealth in positions ranging from children and youth case worker to Chief of Staff for the Office of Medical Assistance Programs (OMAP). She will continue to support OMAP until her replacement is found.
  • Chief of Staff. Johanna Fabian-Marks will serve as DHS Chief of Staff. Ms. Fabian-Marks is coming from the Pennsylvania Insurance Department where she serves as the Special Deputy and Director of Life, Accident, and Health Insurance Product Regulation. Prior to joining the Insurance Department, she worked on implementation of the Affordable Care Act at the Center for Consumer Information and Insurance Oversight at the federal Centers for Medicare and Medicaid Services.
  • Deputy Secretary, Office of Mental Health and Substance Abuse Services (OMHSAS). Lynn Kovich will become the new OMHSAS Deputy Secretary on November 13. Ms. Kovich has 26 years of experience in direct services and administration in both the nonprofit and government sectors, working with individuals who have developmental disabilities, mental illness, and substance use disorders, as well as those experiencing homelessness.

RCPA congratulates each of these individuals and commits to working with them in a constructive manner to advance the best interests of our shared constituencies.