Government Affairs Update
by Kenneth Certa, MD, DLFAPA
The legislature is not in session, and most legislators are working on getting re-elected. As all know, this is a challenging year politically, so few controversial items are likely to be moved forward.
Our committee has been working on a select items of interest, many of which I have mentioned before.
Gambling is hot, as is our interest in limiting the damage gambling disorder can do to the lives of those afflicted and their families. As many know, we adopted a position statement with many suggested actions. We were pleased when the Joint State Government Commission looking at internet gaming suggested adoption of many of the same actions (such as banning the use of credit cards, limiting the use of inducements, reforming self-exclusion, among others.). The report can be found here – Joint State Government Commission’s Report and our position statement here – Position Statement on Mitigating Gambling Harm in Pennsylvania.
These suggestions have been slowly progressing to proposed changes in regulations, for which public comment was invited. PaPS and PSAM submitted comments, found here in paragraphs 3-4 in the PaPS and PSAM HR60 Press Release.
Other bills of note include SB 866, which seeks to classify medetomidine as a controlled substance; the bill is in the Senate Rural and Agricultural Committee. This has already been passed by the house overwhelmingly, HB 2529. We have not taken a position on this issue, despite recognizing the terrible addiction which medetomidine causes (one of its street names is “demon”) as well as a very difficult withdrawal syndrome often requiring an ICU stay. The problem with making it a controlled drug, as many states have done (and there is likely going to be federal action) is that it criminalizes possession, which puts patients at risk of arrest for their addiction. ASAM, and PSAM, similarly oppose placing drugs on controlled substance schedules, preferring to support bans on manufacture and distribution.
Pennsylvania currently has two bills introduced concerning the regulation of kratom, which has similar issues if it is to be placed on a controlled substance schedule. Kratom is more complicated since there is a natural leaf substance which some feel should remain available. We do not expect action on this.
This month the Governor’s office released the Pennsylvania Behavioral Health Council Action Plan, the product of several months of meetings by a number of stakeholders. It does not break too much new ground, but it is heartening to see the attention paid to the needs of the patients we serve. One concern is an interesting change in the Collaborative Care Model, which is referenced in the body of the report as a means to improve access to care. The model, as highlighted in an APA slide that many of us have seen, calls for the involvement of a psychiatric consultant. In appendix A of the report on page 43, the same graphic is used but labels it a psychiatric counselor. We are trying to get some idea from Behavioral Health Council members what the reason for the change is. The report also mentions that there is another integrative care model, the Primary Care Behavioral Health Integration Model (championed by the psychological association) so not sure what the reasoning is for the alteration of an American Psychiatric Association graphic.
There is an effort underway by the OMHSAS and others to revise the outpatient psychiatric clinic regulations, and draft legislation has been shared with us. Kathy Dougherty, Lois Hagarty and I have had meetings with staff from the committee of jurisdiction to see if we can come up with regulations that make sense and we can support. The current regulations (5200 regulations) are in need of revision and include language which mandates a minimum of 2 hours of psychiatric time per direct care employee in the agency. It further states that 50% of that time must be done by a psychiatrist in person in the agency, and the remainder can be by a psychiatrist remotely, or by a CRNP.
There is much confusion about just what psychiatric time means and whether or not it includes supervision or direct patient contact. The state has the authority to grant waivers of these requirements and has been doing so right and left—they would like to get out of the waiver business. RCPA has pushed for greater flexibility, and the proposed legislation is silent on how much psychiatric time should be done by a psychiatrist. It instead mandates that the clinic medical director, a psychiatrist, will make that call.
We are working on language that would mandate a certain amount of time done by a psychiatrist either online or in person and would appreciate input into how much time that should be. Should it be a minimum based on the number of clients served, or employees providing services, or some other metric?
On this and any other matter we are delighted to hear from PaPS members lending their expertise, calling attention to issues of concern, or questioning policies. My email is ken.certa@lenapevf.org, cell is 215-817-9411.