Government Relations Update November 20, 2025 Kenneth Certa MD
We finally have a state budget in Pennsylvania, which is good news
for all who think the legislature should follow the commonwealth
constitution. It is also good news for those agencies which have had to
borrow from their credit lines to make payroll while waiting for money
from the state to start flowing again. Interest payment on this
borrowing is not cheap.
The main features of the budget are an impressive increase in funding
for schools, needed to satisfy a court ruling that the state was
unconstitutionally under-funding some districts. Efforts to increase
revenue by legalizing and taxing cannabis, as well as taxing skill games
were not approved. Cannabis is certainly a complicated subject but most
(not all) psychiatrists are not anxious to open those flood gates.
Gambling regulation and taxation is also complex.
We are not happy with extensive gambling already extant and no bills
have been moved recently to increase regulation including with skills
games. HR60 is underway, however, to conduct a study on sports betting
and related interactive gambling including recommended methods to
further regulate the industry – goal of regulations to reduce problem
gambling behaviors, gambling debt and the exposure of children to sports
betting and related interactive gambling advertisements. A
bipartisan joint commission will be releasing a report of its findings
in May 2026 and our members have been involved in advocacy surrounding
this and also have been working with PSAM to draft a position statement
on mitigating gambling harm in Pennsylvania.
We continue our efforts to maintain safe prescribing, working against
HB 1000. Thanks to everyone who contacted their representatives to voice
their opposition to this scope expansion.
Unfortunately, as was mentioned last month, Senator Gene Yaw, from a
very rural district, has issued a co-sponsorship memo asking for state
senators to sign on to a senate version of psychologist prescribing. The
psychologists in his district paint a picture of how if they only
could prescribe they could help with access issues. We have argued that
this is not true, that access to all mental health services is
problematic, especially the therapy services which psychologists are
well-trained for, and that what we need is a full continuum of care, not
just more prescription pads. There are only 250 prescribing
psychologists in the country despite 20 years of such efforts, out of a
total of 204,300 psychologists in the US. The numbers will not be there
to be meaningful, not enough to justify the risk of poor care. We hope
our PaPS members will contact their senators to
ask that they NOT cosponsor this dangerous scope expansion (which has
not yet been introduced into the senate.)
We continue to promote the use of the collaborative care model to
increase access to quality mental health care across the commonwealth.
We have worked with a number of legislators to try to provide start-up
costs and technical support to rural primary care providers, pairing
them with psychiatrists.
We have signed onto two letters of legislative support jointly with
Pennsylvania ASAM. The first is HB 1974, sponsored by Rep. Arvind Venkat
MD, which would aid counties in establishing contingency management
programs for the treatment of stimulant use disorder. Unlike opioids,
there are few evidence-based treatments for stimulant use disorder, with
the best science backing the provision of a small token reward to a
patient in exchange for a urine test which shows abstinence. It
is generally a non-transferable bus pass or gift card to a
convenience store, and has demonstrated efficacy.
The second is SB 899, which is attempting to regulate the use of
Kratom, a derivative of the mitragyna speciosa plant. There are many who
feel this is a natural alternative to opioids, but in fact what is being
sold in convenience stores and gas stations all over the country is a
highly concentrated, often synthetic substance which is addictive and
dangerous. The bill initially was calling for a ban, but has been
amended to scheduling high concentrations of the psychoactive
components. About half of the states have enacted some form of
regulation, with the FDA considering federal action.
We are considering supporting HB 1519, which states: “A health
insurer or MA or CHIP managed plan may not, as a condition of coverage
for a mental health medication, require prior authorization.” As
attractive as this sounds, there are those who worry about such a
pro-pharma bill (lobbying heavily for it; psychiatry is often tainted
with accusations of being too much in cahoots with drug makers) and
the real world consequences to our mental health system if ever more
expensive drugs are demanded by our patients. Let us know what you
think.
The Mental Health Procedures Act continues to be under review,
spearheaded by Rep. Mike Schlossberg. The main concerns are the ways
that the MHPA is not applied in the same way in each of Pennsylvania’s
counties, and the opinion of many that the criteria for involuntary
commitment are too narrow. Now that the budget has passed, it is likely
that there will be renewed efforts to make things more uniform between
counties which could prove problematic, since processes in Philadelphia
may be different than that in Montour or other counties. The push to
extend the “predictable deterioration” standard in the
Assisted Outpatient part of the act may be even thornier. Many of us are
not at all sure we can make such predictions, and the deprivation of
liberty is a really big deal.
We will continue to monitor this effort.