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Gov. Tom Wolf announces change at state Department of Human Services
By Charles Thompson cthompson@pennlive.com August 17, 2017 Gov. Tom Wolf announced Thursday that he will ask Insurance Commissioner Teresa Miller to take over the reins of the state's sprawling Department of Human Services effective Monday. Wolf had already tapped Miller in May to head what he hoped would become the consolidated end result of a merger of the departments of Human Services, Health, Aging and Drug and Alcohol Programs. The Legislature has, in the interim, declared that the consolidation needs more time. But Wolf is moving forward with Miller's transition, perhaps in part because the current DHS Secretary Ted Dallas has been out on a medical leave since mid-June. Dallas is expected to join Wolf's executive office staff when he returns, according to Wolf's press secretary J.J. Abbott. Abbott could not provide a timeline for that on Thursday. Wolf, in a letter to the affected agency's employees, also noted he will nominate Miller's current chief of staff, Jessica Altman, to succeed her at the state Insurance Department. Both Miller and Altman will need Senate confirmation to assume their new roles permanently, but they can start as the governor's nominees in the interim. Teresa Miller, 42, and an attorney by profession, previously served in federal government with the U.S. Centers for Medicare and Medicaid Services, and as administrator of the insurance division for the Oregon Department of Consumer and Business Services. Earlier in her career, the Oregon native also served as legislative director to former Oregon Gov. Ted Kulongoski, and as an attorney for the Oregon Department of Justice. Miller is a graduate of Pacific Lutheran University in Tacoma, Wash., and holds a law degree from Willamette University College of Law in Salem, Ore. She, her husband Ivan Black, and their daughter live in the Harrisburg area. Altman, a 29-year-old Cornell University graduate, has been working as Miller's chief of staff since June 2015. She had also previously worked for the Centers for Medicare and Medicaid Services before earning a master's in public policy from Harvard. For Information Contact: Erin Connors, 703-907-8562 econnors@psych.org APA Opposes Banning Transgender Service Members from Serving in Military
ARLINGTON, Va. July 27, 2017 – The American Psychiatric Association (APA) today announced its opposition to banning transgender Americans from serving in the military. "The APA stands firmly against discrimination against anyone," said President-Elect Altha Stewart, M.D. "Banning transgender service members from serving our country harms not just those transgender Americans who have dedicated themselves to service of others, but it unfairly casts a pall over all transgender Americans. Discrimination has a negative impact on the mental health of those targeted." The APA in 2012 passed a policy statement that opposed discrimination against transgender people and called for their civil rights to be protected. Transgender people do not have a mental disorder; thus, they suffer no impairment whatsoever in their judgment or ability to work. "Our stand in support of transgender military members is rooted in our policies against discrimination in all forms," said APA CEO and Medical Director Saul Levin, M.D., M.P.A. "We firmly believe the world should be more inclusive. We are encouraged by Joints Chiefs of Staff Chairman Joseph Dunford's statement that there are no modifications to the current policy and we call upon Defense Secretary Mattis to allow transgender service members to continue to serve in the military." The American Psychiatric Association is the oldest medical association in the country founded in 1844. The APA is also the largest psychiatric association in the world with more than 37,000 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA's vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org. Pennsylvania’s Physician General Honored in NBC’s LGBTQ Pride Month Series #PRIDE30
MEDIA CONTACT: April Hutcheson, 717-787-1783 or ra-dhpressoffice@pa.gov Physician General Dr. Rachel Levine is being featured today as a member of NBC's new #PRIDE30; a series of profiles honoring innovators, change makers, and rising stars in the LGBTQ community as part of Pride Month. "People must have the freedom to be themselves and to love who they love, which is what PRIDE is all about," said Dr. Levine. "We have seen significant progress for LGBTQ people over the past several years, but we still have a long way to go. I thank NBC for creating a series like #PRIDE30, which gives a voice to so many outstanding people in our community." Every day during the month of June, NBC releases a new story on an outstanding member of the LGBTQ community. These stories go in depth on what makes the person being profiled an exemplary member of the LGBTQ community and has fun facts like what their hobbies are or what "pride" means to each of the selected members of #PRIDE30. The Wolf Administration fully supports any legislation that protects the LGBTQ community and its fight for equality. Governor Tom Wolf has signed two executive orders to expand protections from discrimination based on sexual orientation, gender expression or identity for state employees and, for the first time, employees of contractors doing business with the commonwealth. The first executive order says that no agency under the governor's jurisdiction shall discriminate against any employee or applicant for employment on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender expression, and identity, national origin, AIDS or HIV status, or disability. The second executive order ensures that all contracting processes of commonwealth agencies will be nondiscriminatory and that all businesses contracting with the commonwealth as well as all grantees should use nondiscriminatory practices in subcontracting, hiring, promoting, and other labor matters. It is estimated that the American workforce loses over $64 billion annually due to losing and replacing more than two million American workers who quit their jobs due to unfairness and discrimination. Pennsylvania is the only state in the Northeast U.S. that does not have legislation to prohibit LGBTQ discrimination. Visit www.health.pa.gov to learn more about the department's efforts to help all Pennsylvanians. APA and AMA issues press releases expressing concerns with ACA replacement bill
As the Trump Administration and Republican Congressional leaders unveiled their Affordable Care Act "repeal and replace" package in early March, the two premier organizations representing physicians acted swiftly in providing comments as to provisions affecting healthcare delivery in the future if the package is enacted. Below are the press releases sent out by each organization. The APA also drafted a provision spreadsheet detailing the current provisions and provisions within the proposed Act. To obtain a copy of the spreadsheet, contact our office. APA Concerned About Proposed ACA Replacement Bill
For Information Contact: Glenn O'Neal, 703-907-8640 press@psych.org Erin Connors, 703-907-8562 econnors@psych.org ARLINGTON, Va. March 7, 2017 – The American Psychiatric Association (APA) is deeply concerned that the proposed ACA replacement released last night will negatively impact care for people with mental illness and substance use disorders. The APA urges continued support and expanded access to quality, evidence-based mental health and substance use services. Mental illness is prevalent in the United States. According to the National Institute of Mental Health, more than 68 million Americans experienced a psychiatric or substance use disorder in the past year. Depression alone has an annual negative economic impact of $210.5 billion. It is unknown how many people will lose coverage under this proposal, but discussions on implementing significant reforms to the current Affordable Care Act and Medicaid raise the possibility that a large number of people with mental illness or substance abuse disorders will lose some or all of their coverage. "While a number of details about the potential impact of the proposed ACA replacement remain unknown, our current understanding of the proposal raises many concerns for people with mental illness," said APA President Maria A. Oquendo, M.D., Ph.D. "Particularly concerning are proposed changes to the Medicaid expansion program. Nearly one-third of people receiving coverage through Medicaid expansion have mental health or substance use disorders." As efforts are made to reform the health system, services for people with mental health and substance use disorders – and their families – must be maintained. We cannot bring down the cost of health care without fully addressing mental health and substance use disorders issues. The American Psychiatric Association offers the following recommendations:
- Establishing lifetime and annual dollar limits on essential health benefits; and - Discrimination based upon health status, including a history of mental illness or substance abuse.
"As Congress considers reforms to health insurance coverage it is critical to maintain the significant progress made over the past three years, through bipartisan efforts, to improve access to mental health care," said APA CEO and Medical Director Saul Levin, M.D., M.P.A. "APA is committed to working with members of both parties in Congress to help ensure adequate access to quality mental health care for all those in need." FOR IMMEDIATE RELEASE
March 8, 2017 AMA says American Health Care Act is Critically Flawed; Points to Reductions in Insurance Coverage, Potential Harm to Vulnerable Patient Populations CHICAGO – In a letter to congressional leaders, the American Medical Association (AMA) today outlined provisions of the American Health Care Act that would have an adverse impact on patients and the health of the nation. Largely due to the decline in health insurance coverage the bill would likely cause, the AMA is unable to support the AHCA as drafted. "The AMA supported health system reform legislation in 2010 because it was a significant improvement on the status quo at the time; and although it was imperfect, we continue to embrace its primary goal – making high-quality, affordable health coverage accessible to all Americans," AMA President Andrew W. Gurman, M.D. said. "As drafted, the AHCA would result in millions of Americans losing coverage and benefits. By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive – if not out of reach – for poor and sick Americans. For these reasons, the AMA cannot support the AHCA as it is currently written." In January, the AMA released its health system reform objectives – primary among them that people who currently have insurance should not become uninsured – and were shared at the time with Members of Congress. In today's letter to congressional leaders, the AMA outlined several provisions within the AHCA where the legislation falls short of the objectives articulated by the AMA. These provisions include:
"As you consider this legislation over the coming days and weeks, we hope that you will keep upmost in your mind the potentially life altering impact your decisions will have on millions of Americans who may see their public, individual or even employer-provided health care coverage changed or eliminated," the AMA said in its letter. "We encourage you to ensure that low and moderate income Americans will be able to secure affordable and adequate coverage and that Medicaid, CHIP, and other safety net programs are maintained and adequately funded. And critically, we urge you to do all that is possible to ensure that those who are currently covered do not become uninsured." Media Contact: AMA Media & Editorial (312) 464-4430 media@ama-assn.org 
Governor holds press conference to tighten medication rules to fight opioid crisis
Governor Wolf held a press conference this past week highlighting the accomplishments of his Administration on fighting the opioid and heroin overdose crisis and next steps. The focus of his reforms is within the Medicaid realm. One of the most significant changes involves revising a current policy allowing non-participating providers that see Medicaid patients as cash clients but prescribe medications for substance use treatment with prescriptions submitted to independent and chain pharmacies under the Medicaid payment structure. Effective April 1st, all ordering, prescribing or referring providers must be enrolled in the Medicaid program. The administration believes that "…this will prevent current cash providers who are not enrolled in the Medicaid program from having their prescriptions filled at the pharmacy." When researching this requirement, we have been told that this is a requirement of the Affordable Care Act that was never enforced in the commonwealth, so it is highly unlikely that this change can be overturned. That being said, please let me now if you have any comments/concerns moving forward. Other changes include working with the PA Department of Drug and Alcohol Programs (DDAP) to eliminate policies allowing Medicaid enrollee cash payments to providers for treatment, auditing/ceasing relationships with providers prescribing substance use medications in an office setting without an in-person appointment, and referring "high volume" providers to DHS' Bureau of Program Integrity for further action. A copy of the press release is below for your convenience. The Society continues to hold a crucial role in the state's substance use initiatives. Dr. Certa and I serve on the Pennsylvania Medical Society's Task Force on Opioids. We are working on providing comments and have been invited to meeting with Attorney General Josh Shapiro soon to discuss next steps. Lois Hagarty, our outside lobbyist, and I continue to meet with members of the Wolf Administration and Representative Matt Baker (chair of the House Health Committee and sponsor of one of the involuntary commitment bills of concern) this coming Tuesday (weather-permitting) to discuss our position on involuntary commitment for substance use and the expansion of Medication Assisted Treatment. As per Council action, we have been directed to draft a position paper on the use of involuntary commitment for substance use (which includes clinical considerations and alternatives). This document should be available soon for Society and member use in grassroots lobbying. Please contact the PaPS office with additional questions or for more information. FOR IMMEDIATE RELEASE
March 6, 2017 Pennsylvania Tightens Medication Rules to Help Combat Opioid Crisis Harrisburg, PA – Today, Governor Tom Wolf announced several additional steps the commonwealth is taking to help combat the opioid addiction crisis. These steps will help tighten the rules under which medication such as buprenorphine can be prescribed under the Medicaid program. "Success in the fight against opioid crisis requires that we address the issue from all angles," said Governor Wolf. "Not only must we make sure that quality treatment options are available from Pennsylvanians suffering from an opioid use disorder, we must also make sure that we are doing everything we can to make sure treatment is appropriate and that we keep unscrupulous individuals from taking advantage of those who are fighting the disease of addiction." In order to help make sure that medication is used appropriately, the Department of Human Services (DHS) will take the following actions for Medicaid providers:
"We are tightening the medication rules to ensure that the Medicaid providers writing these prescriptions are thoroughly treating the individual, coordinating care, and getting folks the counseling services they need while going through this treatment," said DHS Secretary Ted Dallas. "Our physical health, behavioral health, and pharmaceutical providers need to work together to provide the best care possible." "If you, or someone you love, is receiving treatment from an Medicaid-enrolled provider, you should not pay out of pocket for that treatment. We ask that you refer the provider to DHS' tip line at 1-844-DHS-TIPS," said Governor Wolf. In addition to the latest actions, the commonwealth has:
New investments in battling the opioid epidemic in the 2017-2018 budget include:
If an individual needs treatment for substance use disorder, and they are on Medicaid, they should call their MCO to determine a provider that is in their network. If the person is in the fee-for-service program, they can call DHS at 800-692-7462 for assistance in locating a provider. For more information, visit www.pa.gov. Do you prescribe opioids to minors? The mandatory state form is now ready!
ACT 125 Form (pdf) In the December issue of News and Notes, members were informed of the enactment of Act 125 of 2016. The Act creating opioid prescribing limits for minors. Specifically, prescribers are unable to prescribe opioids to a minor for more than seven days unless a parent/guardian signs a form authorizing the prescription OR for no more than 72 hours if an authorized adult signs the form on behalf of a minor when a parent/guardian is not present. Under the law, an "authorized adult" is defined as "an adult who has a valid health care proxy to consent to the minor's medical treatment." Exceptions to the seven-day limit are when the prescription is for the management of pain associated with cancer, for use in palliative/hospice care, for management of chronic pain not associated with cancer, and when a prescriber (in their medical judgment) believes that the use of medication for longer than a week will stabilize a minor's acute medical condition. Documentation must be accompanied for the exception to the seven-day rule when establishing stabilization of a minor's acute condition. Treating a minor for a medical emergency or when complying with the law would jeopardize the minor's health or safety is also an appropriate reason for deviating from the provisions of Act 125. The Act takes effect as soon as the Bureau of Professional and Occupational Affairs can finalize the standardized prescription form. The consent form was finalized in early February and published in the Pennsylvania Bulletin. The form is available now online at http://www.pabulletin.com/secure/data/vol47/47-5/191.html. A PDF copy of the form is attached for your review here. As stated within the legislation, the form requires information on the prescription (name of medication, quantity, initial dosing details, refill amount) and requires the prescriber to formally ensure that the minor patient and their parent/guardian/authorized adult has been informed of the following: 1) risks of addiction/overdose related to opioid medication; 2) increased risk of addiction to controlled substances for individuals with behavioral health needs; 3) the dangers of taking any opioid in conjunction with use of benzodiazepines, alcohol or other central nervous system depressants; and 4) other information in the patient counseling information section of the federal regulation 21 CFR 201.57 (c) (18). Copies of the certification form(s) must be kept in the patient record. NOTE: Per state law, the PA Prescription Drug Monitoring Program must be checked prior to prescribing any opioid or benzodiazepine REGARDLESS OF THE AGE OF THE PATIENT. If you have any additional questions or need more information, contact Deb Shoemaker, Executive Director, via phone (800.422.2900) Mental Health Parity resources from the APA: The Consumer Portal:
Consumer Guide to Disclosure Rights
Learn more APA Expresses Concerns About Executive Order on Temporary Immigrant Travel Ban
On January 27, President Donald J. Trump signed an executive order placing a temporary ban on immigrants from seven countries - Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen. Read the following message sent on behalf of Saul Levin, MD, CEO and Medical Director of the American Psychiatric Association, that shares APA's concerns about the ban. DEA Changes Registration : Important Notice
Through a notice on its website, the Drug Enforcement Administration (DEA) recently announced significant changes to its registration renewal process. Effective January 1, 2017, the DEA is eliminating the informal grace period which the agency has previously allowed for registrants to renew their registrations. Only one renewal notice will be sent to each registrant's "mail to" address approximately 65 days prior to the expiration date; no other reminders to renew the DEA registration will be provided. The notice also advises that online capability to renew a DEA registration after the expiration date will no longer be available, and that failure to file a renewal application by midnight EST of the expiration date will result in the "retirement" of the registrant's DEA number. The original DEA registration will not be reinstated. In addition, paper renewal applications will not be accepted the day after the expiration date. If DEA has not received the paper renewal application by the day of the expiration date, mailed in renewal applications will be returned and the registrant will have to apply for a new DEA registration. Both the American Medical Association and the American Psychiatric Association have expressed concerns to the DEA about these policy changes and the inconveniences this could cause both patients and providers. If you run into snags, contact the PaPS office at dshoemaker@pamedsoc.org or at 1-800-422-2900. 
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