Monitoring budget approvals and the potential for legislative posturing to include legalizing recreational cannabis and “skill games” as well as Psychology prescribing, prior authorization, communicating safe ways to use AI in mental health and requiring “school life support coaches” continues as this year’s legislative session progresses.
As the spring progresses, much of the focus in Harrisburg centers on the governor’s proposed budget, and what the legislature is going to do with it. The budget itself is not particularly different from past ones; our major concerns about it involve the horse-trading which can sometimes accompany the wrangling to get it passed. Surprises can happen.
Two things which again appear in the budget are calls for legalization of recreational cannabis, and regulation of “skill games,” both in the interest of raising revenue. Our impression is that most psychiatrists are not keen on increasing use of cannabis but recognize this is not a universal opinion; we’d love to hear from members who would like to push for PaPS support. Many of us see the negative effects of increased psychosis and lack of motivation among heavy users and so would rather not increase availability.
“Skill games” regulation raises the thorny problem of how best to address the explosion of gambling in many forms throughout society. We have all seen individuals who have suffered greatly from the addictive nature of this, particularly young men, but others as well. We have worked with the Pennsylvania Society of Addiction Medicine to develop a position statement on gambling and review proposed legislation such as this through that lens. We have provided this input to a joint house-senate task force looking into gaming, hoping to do what we can to limit the real damage to people’s lives.
Last month we discussed the psychology prescribing bill now in the senate. Please consider contacting your state senator to give your opinion on such unsafe scope expansion. Our committee has been in touch with many members of the senate, but most legislators are interested primarily in hearing from constituents.
HB 1519 is one which we have had much discussion about. It essentially bans prior authorization for medication used for treatment of mental illness. The meat of the bill states as follows:
(c.1) A health insurer, MA, or CHIP managed care plan may not, as a condition of coverage for a mental health medication, require prior authorization.
As annoying as prior auth is, many of us have concern that this could lead to problematic consequences. This could remove the ability to preserve scarce medications for those patients most in need, and it could impair needed safety checks. It could further skew expenditures for mental health needs in the direction of medication, which might only bring marginal benefit, while starving money for other forms of therapy. We are considering ways to amend which can address these problems. In reality, the insurance lobby is likely to keep this from becoming law as is; we are hoping to amend in such a way as to help get some real relief from most prior authorization.
Hearings have been held by the Committees of Health and Communications & Technology where proposed legislation concerning AI in health care are sitting. We are grateful to Kirklan Kathe MD, a member of our GR committee and a forensics fellow at the University of Pennsylvania, for presenting testimony on behalf of the society. We are hoping to head off outright bans on AI in mental health settings (which have been proposed) and pointed out the utility of in-session decision support, as well as record keeping.
HB 2253 has been introduced, to require “school life support coaches” in high schools as a way to supplement the work being done by guidance counselors and school psychologists. The bill notes that hiring additional clinical staff is not financially feasible. We are concerned about the duties as follows (text copied directly from HB 2253):
(1) Provide daily one-on-one or small group social emotional support.
(2) Respond to nonclinical emotional crises, including panic, grief, or stress, refer students requiring clinical intervention to licensed staff and document referrals in accordance with district policy.
(3) Mentor students at risk of disengagement, isolation, or dropout.
These very closely approximate clinical roles, despite being labeled as otherwise. While well-intentioned, the questions about confidentiality, record-keeping, consent, and scope are very worrisome and will bear watching.
We are always interested in hearing from members with concerns, as well as about interactions you have had with members of the legislature. My best email is certafamily@aol.com.