Government Affairs Update – September 2026

The legislature is in recess until September 28. There are only nine days left (three in September and six in October) of session before another recess prior to the elections in November. We do not expect much action during this time.

What happens following the election will depend on the results. It is unclear if the potential “blue wave” expected nationally will carry to local races in Pennsylvania. If it does, and the state senate flips from Republican to Democratic control, we are likely to see much more movement in legislation that has been stalled by the partisan and philosophical differences.

What this could mean is that our so-far successful efforts to prevent unsafe prescribing may be challenged. In general, Republicans favor maintaining higher standards for granting privileges to prescribe (as well as do many other things), while Democrats have favored the easier-access argument. We believe we have made our case well, but the problems of access to health care are likely to escalate. More and more individuals are being left without health insurance due to increasing costs and federal cuts to Medicaid eligibility. While one cannot draw a straight line between lack of health care access and “let’s let more people prescribe,” there are some who will make this argument. Our members must be prepared to push back that access to medication by less well-trained providers is not the same as better health care. Better mechanisms exist, especially the Collaborative Care Model.

The Office of Mental Health and Substance Abuse Services (OMHSAS) has issued final regulations concerning privacy rights in the mental health system, which attempt to clarify the control of minors’ records, as well as harmonize the Mental Health Procedures Act (MHPA) with HIPAA. We had reviewed the proposed regulations and did not find any serious problems with them, and do not think practitioners will notice a difference. One notable issue is that some circumstances for record release which had not specified the need for a written release (only the consent of the patient) now make that written requirement. Preserved is the principle that anyone who has provided care to a patient does not need a release to provide records to someone else currently treating the patient. This nonconsensual release is important to those of us working in emergency settings, where such access is vital to provide quality care.

We continue to see some benefits from efforts of Drs. Kavita Fischer and Robert Tessier, among others, to highlight problems with the explosion of gambling in the commonwealth. The potential seizure of thousands of “skill game” consoles by the state police has gotten the attention of our citizenry and forced the legislature to come to terms with how to regulate them, which the state Supreme Court has ruled are essentially slot machines and not exempt from regulation as the manufacturers and businesses that house them have claimed. How this will play out will be interesting to watch, but more important is the bright light shone on our message that gambling is a public health risk that must be more tightly regulated.

OMHSAS continues to work with other aspects of the MHPA, in particular efforts to ensure that counties are using the same guidelines, standards, and forms. Representative Mike Schlossberg is proposing efforts to introduce legislation for more ambitious changes. Currently, the “predictable deterioration” standard applies for assisted outpatient treatment; his co-sponsorship memo proposes to expand this as a criterion for inpatient treatment.

Many of us see this as potentially problematic, especially since there has been so little experience with this standard in the outpatient setting. Act 106 of 2018 allowed counties to opt out of providing AOT due to logistical and fiscal impediments. Counties that had earlier elected not to opt out (such as Dauphin and Bucks, where I work) still have not been able to set up programs. In January of this year, Allegheny County initiated a program which is beginning to enroll a very small (single-digit) number of patients. There are many good arguments on both sides of this debate, from civil rights concerns and clinical efficacy to the tremendous cost for a limited number of patients. The longstanding program in New York is very effective for the few patients receiving services, but many question whether the money might be better spent in other ways, for more patients.

Our committee is engaged in an effort to develop a position statement on prior authorization. HB 1519 and SB 1409 have been introduced calling for a ban on prior authorization for medications used for the treatment of serious mental illness, defined as: (i) schizophrenia spectrum and other psychotic disorders; (ii) bipolar and related disorders; (iii) depressive disorders; (iv) anxiety disorders; (v) obsessive-compulsive and related disorders; and (vi) feeding and eating disorders. The potential to rid ourselves of such a requirement, which takes up enormous time and delays care, is very appealing. Some have concerns about whether there need to be some guardrails, such as limiting this to board-certified psychiatrists, as is APA policy, and whether this should include other prescribers such as nurse practitioners. We are taking a look at the experience of other states, as well as cost and practicality of passage of such a bill. Any member of PaPS who has an interest is encouraged to let us know your thoughts.