Government Affairs Update
by Kenneth Certa, MD, DLFAPA
The government relations committee is addressing several issues of concern to PaPS members and citizens of the commonwealth.
June is budget season, and we follow the debate on programs and funding as best we can (much is taking place behind closed doors). In particular, efforts to bring in new revenue by expanding gambling regulation and taxation to “skill games” run the risk of worsening the epidemic of problem gambling. We have been active with the Pennsylvania Society of Addiction Medicine working to educate the legislature about the public health consequences of the current gaming explosion and look to Harrisburg and Washington for responsible practices. Too many of our citizens are being bankrupted by gambling addiction, leading to loss of self respect, shame, depression, and suicidality.
The other easy money that the governor proposes is the taxation of legalized cannabis. Our position is in principled opposition, despite the progression of legalization across the country, again from a public health perspective. There is no evidence that cannabis is an effective treatment for any mental health condition, despite the claims of proponents. There is much evidence of the dangers, especially to developing brains. Balancing the good that can come from more revenue to fund programs and the ills to our patients, we continue in opposition. Our chief lobbying is education about the science.
Our friend in the house mental health caucus Mike Schlossberg is circulating a co-sponsorship memo concerning upcoming legislation to amend the Mental Health Procedures Act. We have been active in providing input into this for some time and look forward to some of the main reforms (chiefly making the process more uniform across the commonwealth, though we think the state could do this on its own). We will watch carefully efforts to expand the criteria for involuntary commitment to include “predictable psychological deterioration” as some states include, with concern about whether this is as predictable as proponents suggest. We may have a situation with far more people being committed to inpatient care with no more resources to care for them, and liability if our predictive powers fall short. We wait to see the legislative language
The state is again seeing to change outpatient psychiatric clinic regulations to make it easier to staff clinics by telehealth as well as non-psychiatrists. The current regulations are in need of reform, with many inconsistencies and restrictions which has caused the state to grant a multitude of waivers–they are hoping to get out of the waiver business. We would like to see maintained regulatory requirements for a certain percentage of care in psychiatric clinics to be performed by psychiatrists and resist the current efforts at enshrining in law a near-equivalency of psychiatrists and nurse practitioners. Access to care means access to quality care.
In the same vein, the governor’s office is proposing an Any Willing Providers act for behavioral health care. It seeks to remove barriers to care by requiring insurers to accept any provider who meets licensure requirements, so long as they accept the fee schedule and practice requirements of already credentialed providers. We have concerns that such bills have been used by non-physician practitioners to push for equivalency of payment, so nurse practitioners must be paid the same as psychiatrists, since they are providing the same service (this is happening in Washington state.) We will seek clarity and possibly amendment to prevent this.
Safe prescribing continues to be under attack by bills in the state house and senate. To this point we have been able to prevent psychology prescribing bills from progressing out of committee. This requires constant contact with the members of the House Professional Licensure Committee (HB 1000) and the Senate consumer Protections and Professional Licensure Committee (SB 1243) as well as legislative leadership. Access to care means access to all aspects of quality mental health care; psychologists are in critical shortage as well as all members of the behavioral health care team. Increasing their scope does not grow this team; it risks continuing the false premise that access to psychotropics means access to care. We need good psychotherapy and diagnostic testing; most psychologists recognize their worth and are not interested in doing something that they know they do not have the training. This is why even in states with this authority, after over 20 years, there are fewer than 250 nationwide prescribing psychologists, doing nothing to increase access to care.