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Compliance Actions Related to Opioid Epidemic Statewide Emergency

Healthcare Alert | January 11, 2018
By: Kate Woods

On Wednesday, January 10, 2018, Pennsylvania Governor Tom Wolf, acting under the authority of his office declared the heroin and opioid addiction epidemic a statewide emergency. This designation will allow for temporary override of rules and regulations that may be seen as impeding viable ways of developing long term policy solutions and addressing the epidemic. Pennsylvania joins seven other states in making such a designation. Alaska, Arizona, Florida, Maryland, Massachusetts, South Carolina, and Virginia have also authorized similar declarations. 

Declaration of emergency status helps further state goals of supporting better coordination of care for those in need of treatment and identifying and releasing additional funding sources to address the holistic problem. While temporary in nature, Governor Wolf’s declared state of emergency empowers the legislature and regulatory agencies to act within the authority already accorded them and to engage in concerted efforts directed towards increasing access to treatment facilities and behavioral health treatment options throughout the state, and increased availability of Naloxone for treatment use in emergency overdose situations.

In related news, New Jersey Governor Chris Christie recently signed New Jersey S.B. 2964, which is an Act concerning housing options for individuals receiving treatment for a substance use disorder. This Bill has a high likelihood of passage. If successful, it will amend the law in New Jersey to ensure that individuals receiving medication assisted treatment for substance use disorders are not denied admission to residential treatment facilities based on this status (amends section 9 of Alcoholism Treatment and Rehabilitation Act, P.L. 1975, c.305 (C26:2B-15).

These two recent state actions focusing on the heroin and opioid epidemic indicate that 2018 will likely prove to be another year of targeted focus on behavioral health and substance use disorders at state and federal levels. The continued focus on substance use disorders and the epidemic of abuse necessarily requires healthcare organizations be aware of the changes to laws and regulations specifically affecting their industries or operations. And, as important, to position themselves to rapidly respond to new governmental requirements as they develop. Positioning for rapid response and implementation of compliance mandated operational changes can help healthcare organizations manage risks associated with such regulatory change. A focused approach can help healthcare organizations control for operational disruption and financial impact, if any, while implementing any necessary changes. Change is coming in the mental health and substance use disorder healthcare sector - the question is not if or when but how soon and how frequent.

Some actions healthcare organizations and providers can take to ensure compliance and operational excellence related to substance use disorders and treatment include:

Policies & Procedures

  • Review corporate and applicable department level policies and procedures (e.g. claims processing, medical policies, network adequacy, pharmacy tiered formularies, claims submission and coding requirements).

Annual Compliance Work Plan

  • As an example, subsequent to internal risk assessment process, health plans may want to consider inclusion of mental health parity as a designated area of focus (e.g. regulation tracking and dissemination of requirements to appropriate product lines and business units, parity testing analysis, review of claims, specific policies and work procedures).
  • Review and analysis of compliance with the Mental Health and Addiction Equity Act (MHPAEA) regulations is a good place to start followed by specific applicable state laws and regulations).
  • Substance Use Treatment facilities may find it beneficial to increase focus on understanding specific benefit plans and Certificates of Coverage to ensure patient eligibility and accurate claims submission. 

Education and Training

  • Determine if the need exists for updates to your new hire and annual training programs related to mental health parity, substance use disorder facilities, or other behavioral health regulations at federal and applicable state levels.

Vendor Oversight

  • Identify vendors providing subcontracted healthcare services in the behavioral health sector or which services may impact same.
  • Develop or modify existing vendor oversight program to ensure compliance. 
  • Healthcare providers and companies providing subcontracted healthcare services should conduct an internal review to ensure continued capabilities of meeting healthcare clients’ regulatory compliance needs, including the ability to properly document compliance with applicable rules, regulations, and client company policies in the event of an audit.

Realigning operational procedures to regulatory requirements works best under the “measure twice, cut once” principle. Let the rule or regulation help guide the implementation discussion. It need not drive to a predetermined outcome and there are usually at least several ways to successfully comply with a given requirement while also meeting business objectives. But implementing operational changes based on new or modified laws, regulatory requirements, or public policy for that matter, is almost never easy. Creating the institutional structure and work plan processes needed to effectively and rapidly implement those changes is an investment of time and resources that can yield a positive return on investment. These positive returns can include protection from compliance nonconformity and any attendant sanctions or censures and accuracy in implementation of operational changes that can often result in efficiencies and the mitigation of misdirected company resources when properly executed.

If you have questions or would like additional information, contact Kate Woods ( | 215.864.6376) or a member of our Healthcare Group. 

This correspondence should not be construed as legal advice or legal opinion on any specific facts or circumstances. The contents are intended for general informational purposes only, and you are urged to consult a lawyer concerning your own situation and legal questions.
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