On July 18, 2019, Pennsylvania’s Independent Regulatory Review Commission (“IRRC”) unanimously approved the final-form regulations regarding outpatient psychiatric services and psychiatric outpatient clinics. In 2013, the Pennsylvania Department of Human Services (“DHS”) sought input on updating potentially-outdated regulations and comporting them with a changed statutory landscape. In developing the revised regulations, DHS had its eye on the 285 community-based psychiatric outpatient clinic programs and their 2,264 satellite sites that served 325,851 individuals through the expenditure of public funds in the Commonwealth’s 2013-2014 fiscal year.
The regulatory changes would amend 55 Pa. Code §§ 1153 and 5200, which address outpatient psychiatric services and psychiatric outpatient clinics, respectively. The primary areas of change are in psychiatric time, staffing patterns and timeframes for developing and updating treatment plans. Regarding psychiatric time, the new regulations would allow 50% of required psychiatric time to be provided by advanced practice professionals or through the use of tele-behavioral health, while the other 50% of psychiatric time would need to be provided by a psychiatrist at the clinic.
Regarding staffing patterns, the new regulations allow 50% of treatment staff providing psychotherapy to be mental health professionals and require two hours of psychiatric time for each full-time equivalent (“FTE”) mental health professional and mental health worker per week. Currently, a clinic must have a psychiatrist in-clinic for 16 hours per week and employ four FTE mental health professionals. Further, advanced practice professionals, certified registered nurse practitioners (“CRNP”) and physician assistants will be allowed to serve as primary professionals serving individuals receiving medication management solely at a psychiatric outpatient clinic, so long as such professionals are prescribing medication within their respective scopes of practice.
Regarding treatment plans, the new regulations establish a 30-day timeframe for the development, review, and sign-off of the initial treatment plan (currently 15 days) and a 180-day timeframe for treatment plan updates (currently 120 days). A psychiatrist, CRNP, or a licensed clinical psychologist will be permitted to sign the initial treatment plan, a right currently reserved only to psychiatrists. Also, the patient will be asked to sign the plan updates in an effort to encourage a more collaborative treatment approach.
As mentioned in the introductory paragraph, the regulatory changes address statutory changes – in particular, those resulting from the 2008 Mental Health Parity and Addiction Equity Act as expanded by the Affordable Care Act (“ACA”) in 2010. The revised regulations take into account changes in the benefit packages resulting from the implementation of Medicaid expansion under the ACA. Further, the revised regulations satisfy a requirement in Section 4 of the Outpatient Psychiatric Oversight Act, signed into law on May 31, 2018, to promulgate supervision regulations.
Beyond statutory conformity, the regulatory changes codify the requirements for the delivery of Mobile Mental Health Treatment (“MMHT”) services outlined in Medical Assistance Bulletin 08-06-18 issued November 30, 2006. Specifically, the regulatory changes will expand the utilization of MMHT services for individuals under 21 years-old and allow the use of tele-behavioral health as an option for service delivery. Of note regarding the age limit, the regulations currently define an adult as an individual 21 years of age and older. As adulthood is commonly understood to be 18 years of age and older, the regulatory changes address the confusion caused by the current definition.
There are changes beyond those described above, so please review the full text of the regulatory changes. Now that the new regulations received the IRRC’s imprimatur, the Office of the Pennsylvania Attorney General will perform a final review before DHS publishes them.