What in the World will Happen after September 30? More Chaos, Unfortunately
September 20, 2021
We are now in Year Two of “Our World According to COVID-19”. In my last newsletter article, I was cautiously optimistic that COVID would be taking a downturn as more and more individuals were getting vaccinated. However, now we are dealing with the Delta variant, third booster shots, controversial discussions on mandatory vaccinations and masking in schools, and how to tackle COVID during an upcoming flu season.
On the federal level, the Biden Administration continues to extend the Public Health Emergency Declaration. If it is in place, any federal rulemaking or policies that were relaxed or initiated during the pandemic remain in effect. Both the Society and our friends at the APA will continue to advocate for those policies successful in providing patient care during the pandemic continue until the declaration is over and/or beyond if applicable. National medical specialty organizations are keeping on top of these important issues and will continue to engage their state organizations/district branches to jump into action.
However, at the state level, there is much work to do. The state legislature enacted legislation that required a constitutional amendment change to limit any governor’s authority to declare a Public Health Emergency (PHE) to 21 days- regardless of the issue. Act 21 of 2021 was signed into law on June 11, 2021. Implementation of the Act allowed for an extension of all temporary/suspended regulations and policies relaxed under COVID through September 30, 2021, unless terminated sooner by the agency that issued the suspension.
For sake of reference, all changes to the Pennsylvania Constitution must be voted upon by voting citizens of the commonwealth prior to being enacted. This past spring, the referendum was on the state primary ballot and passed by majority vote. The enactment of Act 21 has set Pennsylvania apart as the only state across the nation limiting their governor’s powers during a public health emergency (or any emergency declaration for that matter).
So, what does that mean for PAO-HNS? The end of our state’s PHE is September 30. I have been reviewing the significant impact of these changes for our members. The list of commonwealth policies, regulations, and policy statements relaxed and/or temporarily eliminated during the PHE is too long to list in this article. However, I would like to highlight waivers that directly affect your daily practice of medicine.
On the federal level, the Biden Administration continues to extend the Public Health Emergency Declaration. If it is in place, any federal rulemaking or policies that were relaxed or initiated during the pandemic remain in effect. Both the Society and our friends at the APA will continue to advocate for those policies successful in providing patient care during the pandemic continue until the declaration is over and/or beyond if applicable. National medical specialty organizations are keeping on top of these important issues and will continue to engage their state organizations/district branches to jump into action.
However, at the state level, there is much work to do. The state legislature enacted legislation that required a constitutional amendment change to limit any governor’s authority to declare a Public Health Emergency (PHE) to 21 days- regardless of the issue. Act 21 of 2021 was signed into law on June 11, 2021. Implementation of the Act allowed for an extension of all temporary/suspended regulations and policies relaxed under COVID through September 30, 2021, unless terminated sooner by the agency that issued the suspension.
For sake of reference, all changes to the Pennsylvania Constitution must be voted upon by voting citizens of the commonwealth prior to being enacted. This past spring, the referendum was on the state primary ballot and passed by majority vote. The enactment of Act 21 has set Pennsylvania apart as the only state across the nation limiting their governor’s powers during a public health emergency (or any emergency declaration for that matter).
So, what does that mean for PAO-HNS? The end of our state’s PHE is September 30. I have been reviewing the significant impact of these changes for our members. The list of commonwealth policies, regulations, and policy statements relaxed and/or temporarily eliminated during the PHE is too long to list in this article. However, I would like to highlight waivers that directly affect your daily practice of medicine.
PA DEPARTMENT OF STATE WAIVERS ENDING SEPTEMBER 30
Telemedicine:
On March 18, 2020, as part of Governor Wolf’s PHE, the Pennsylvania Department of State (DOS/Department) was afforded the ability to allow healthcare practitioners licensed under their purview to provide treatment and services to patients via telemedicine while the PHE was in effect. The ability of licensed physician and non-physician healthcare providers to provide telemedicine in the commonwealth has been a lifesaver for current patients and those individuals reaching out for assistance for the first time.
Emergency Paper Prescriptions within 72 Hours:
Last May, the Department was granted the ability to temporarily suspend the State Board of Medicine regulation requiring a paper prescription within 72 hours for PRN medications dictated via phone. The temporary suspension was requested following guidance provided by the Drug Enforcement Agency (DEA) and a related waiver subsequently issued by the Pennsylvania Department of Health (DOH). To eliminate any potential confusion that may arise, DEA, DOH and DOS uniformly required prescribers to deliver paper prescriptions for emergency oral prescriptions as soon as is practical, but at the very latest must do so within 15 days to remain in compliance. This waiver will now end on September 30.
Out-of-State Health Care Practitioners:
This waiver allowed the issuance of expedited temporary licenses to practitioners in other states to provide services to Pennsylvanians. The suspension applied to the State Board of Medicine, the State Board of Osteopathic Medicine, and the State Board of Nursing. This included the use of telemedicine across state borders.
Medical Doctors and the Number of Affiliated Institutions:
This waiver suspended the institutional-license requirements that limited qualified medical doctors to practice at no more than two affiliated facilities.
CRNPs, Physician Assistants (PAs):
Waivers allowing CRNPs, PAs to assist with COVID-19 emergency response efforts more easily and effectively by suspending requirements pertaining to written agreements and several other items will expire on September 30th.
Buprenorphine Treatment Via Telemedicine Expanding Access to Treatment of Opioid Use Disorder (OUD):
Consistent with guidance from SAMSHA and the PA Department of Drug and Alcohol Programs (DDAP), DOS waived the requirement that an initial medical history and initial physical examination be performed, unless emergency circumstances justify it necessary to start treatment. This requirement curtailed access to buprenorphine provided via telemedicine and the potential barrier for individuals who would benefit greatly from buprenorphine treatment. This waiver was specifically limited to the treatment of OUD with the FDA-approved, office-based treatment medication buprenorphine.
On March 18, 2020, as part of Governor Wolf’s PHE, the Pennsylvania Department of State (DOS/Department) was afforded the ability to allow healthcare practitioners licensed under their purview to provide treatment and services to patients via telemedicine while the PHE was in effect. The ability of licensed physician and non-physician healthcare providers to provide telemedicine in the commonwealth has been a lifesaver for current patients and those individuals reaching out for assistance for the first time.
Emergency Paper Prescriptions within 72 Hours:
Last May, the Department was granted the ability to temporarily suspend the State Board of Medicine regulation requiring a paper prescription within 72 hours for PRN medications dictated via phone. The temporary suspension was requested following guidance provided by the Drug Enforcement Agency (DEA) and a related waiver subsequently issued by the Pennsylvania Department of Health (DOH). To eliminate any potential confusion that may arise, DEA, DOH and DOS uniformly required prescribers to deliver paper prescriptions for emergency oral prescriptions as soon as is practical, but at the very latest must do so within 15 days to remain in compliance. This waiver will now end on September 30.
Out-of-State Health Care Practitioners:
This waiver allowed the issuance of expedited temporary licenses to practitioners in other states to provide services to Pennsylvanians. The suspension applied to the State Board of Medicine, the State Board of Osteopathic Medicine, and the State Board of Nursing. This included the use of telemedicine across state borders.
Medical Doctors and the Number of Affiliated Institutions:
This waiver suspended the institutional-license requirements that limited qualified medical doctors to practice at no more than two affiliated facilities.
CRNPs, Physician Assistants (PAs):
Waivers allowing CRNPs, PAs to assist with COVID-19 emergency response efforts more easily and effectively by suspending requirements pertaining to written agreements and several other items will expire on September 30th.
Buprenorphine Treatment Via Telemedicine Expanding Access to Treatment of Opioid Use Disorder (OUD):
Consistent with guidance from SAMSHA and the PA Department of Drug and Alcohol Programs (DDAP), DOS waived the requirement that an initial medical history and initial physical examination be performed, unless emergency circumstances justify it necessary to start treatment. This requirement curtailed access to buprenorphine provided via telemedicine and the potential barrier for individuals who would benefit greatly from buprenorphine treatment. This waiver was specifically limited to the treatment of OUD with the FDA-approved, office-based treatment medication buprenorphine.
PA DEPARTMENT OF HUMAN SERVICES (DHS) GUIDANCE ON TELEMEDICINE AND RELATED WAIVERS:
Before you hang your head and put your hands up in despair, there are few lights at the end of this tunnel. First off, if you are a DHS-enrolled provider, it appears that they intend to continue the ability to perform telemedicine for their enrollees. Specifically, the Office of Mental Health and Substance Use Services (OMHSAS) unveiled an updated Bulletin in late August to address the use of telemedicine after the PHE has ended in the commonwealth. Although there are some clarifications being asked of the Department related to use of audio-only telemedicine and payment, it appears that DHS is dedicated to retaining the use of telehealth and limit the disruption of treatment and services for their enrolled consumers.
To view a copy of the update telemedicine bulletin, click here.
As chair of DHS’ Office of Medical Assistance Programs’ Medical Assistance Advisory Committee (MAAC), I intend to keep on top of initiatives and policy changes that affect how you provide crucial, often life-sustaining services to individuals and families across the commonwealth.
In closing, our colleagues at PAMED, along with various coalition partners, are taking the lead on grassroots advocacy efforts. PAO-HNS is involved in many of these coalition meetings to reinforce those key initiatives must remain in place to ensure that our patients do not have a disruption of service or face additional barriers in obtaining care. In the meantime, please do not hesitate to contact me at dshoemaker@pamedsoc.org or via phone at 717.909.2689 with any questions, clarifications, concerns, or additional information as we navigate this new complicated world after September 30.
You are not alone. The Society will continue to fight for you during this difficult time.
To view a copy of the update telemedicine bulletin, click here.
As chair of DHS’ Office of Medical Assistance Programs’ Medical Assistance Advisory Committee (MAAC), I intend to keep on top of initiatives and policy changes that affect how you provide crucial, often life-sustaining services to individuals and families across the commonwealth.
In closing, our colleagues at PAMED, along with various coalition partners, are taking the lead on grassroots advocacy efforts. PAO-HNS is involved in many of these coalition meetings to reinforce those key initiatives must remain in place to ensure that our patients do not have a disruption of service or face additional barriers in obtaining care. In the meantime, please do not hesitate to contact me at dshoemaker@pamedsoc.org or via phone at 717.909.2689 with any questions, clarifications, concerns, or additional information as we navigate this new complicated world after September 30.
You are not alone. The Society will continue to fight for you during this difficult time.
General Assembly Session Dates
2021 SENATE SESSION
September 20, 21, 22, 27, 28, 29
October 18, 19, 20, 25, 26, 27
November 8, 9, 10, 15, 16, 17
December 13, 14, 15
2021 HOUSE SESSION SCHEDULE
September 13, 14, 15, 27, 28, 29
October 4, 5, 6, 25, 26, 27
November 8, 9, 10, 15, 16, 17
December 13, 14, 15
September 20, 21, 22, 27, 28, 29
October 18, 19, 20, 25, 26, 27
November 8, 9, 10, 15, 16, 17
December 13, 14, 15
2021 HOUSE SESSION SCHEDULE
September 13, 14, 15, 27, 28, 29
October 4, 5, 6, 25, 26, 27
November 8, 9, 10, 15, 16, 17
December 13, 14, 15
