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022420 Health DDAP COMMONWEALTH OF PENNSYLVANIA HOUSE OF REPRESENTATIVES APPROPRIATIONS COMMITTEE HEARING STATE CAPITOL MAIN BUILDING ROOM 140 HARRISBURG, PENNSYLVANIA MONDAY, FEBRUARY 24, 2020 PRESENTATION FROM DEPARTMENT OF HEALTH AND DEPARTMENT OF DRUG & ALCOHOL PROGRAMS BEFORE: HONORABLE STANLEY SAYLOR, MAJORITY CHAIRMAN HONORABLE MATT BRADFORD, MINORITY CHAIRMAN HONORABLE ROSEMARY BROWN HONORABLE SHERYL DELOZIER HONORABLE GEORGE DUNBAR HONORABLE JONATHAN FRITZ HONORABLE MATT GABLER HONORABLE KEITH GREINER HONORABLE SETH GROVE HONORABLE MARCIA HAHN HONORABLE DOYLE HEFFLEY HONORABLE JOHN LAWRENCE HONORABLE JASON ORTITAY HONORABLE CLINT OWLETT HONORABLE CHRIS QUINN HONORABLE GREG ROTHMAN HONORABLE JAMES STRUZZI HONORABLE JESSE TOPPER HONORABLE JEFF WHEELAND HONORABLE RYAN WARNER HONORABLE MARTINA WHITE ————————— JEAN DAVIS REPORTING POST OFFICE BOX 125 • HERSHEY, PA 17033 Phone (717)503-6568 1 BEFORE (cont.'d): HONORABLE DONNA BULLOCK 2 HONORABLE MORGAN CEPHAS HONORABLE CAROLYN COMITTA 3 HONORABLE AUSTIN DAVIS HONORABLE ELIZABETH FIEDLER 4 HONORABLE MARTY FLYNN HONORABLE EDWARD GAINEY 5 HONORABLE PATTY KIM HONORABLE STEPHEN KINSEY 6 HONORABLE LEANNE KRUEGER HONORABLE STEPHEN McCARTER 7 HONORABLE BENJAMIN SANCHEZ HONORABLE PETER SCHWEYER 8 9 ALSO IN ATTENDANCE: 10 DAVID DONLEY, REPUBLICAN EXECUTIVE DIRECTOR RITCHIE LaFAVER, REPUBLICAN EXECUTIVE DIRECTOR 11 ANN BALOGA, DEMOCRATIC EXECUTIVE DIRECTOR TARA TREES, DEMOCRATIC CHIEF COUNSEL 12 HONORABLE MARY JO DALEY HONORABLE PAM DeLISSIO 13 HONORABLE CRIS DUSH HONORABLE DAN FRANKEL 14 HONORABLE JOE HOHENSTEIN HONORABLE MARY ISAACSON 15 HONORABLE SARA INNAMORATO HONORABLE DARYL METCALFE 16 HONORABLE TOM MURT HONORABLE KATHY RAPP 17 HONORABLE GREG VITALI HONORABLE DAVE ZIMMERMAN 18 19 20 21 JEAN M. DAVIS, REPORTER NOTARY PUBLIC 22 23 24 25 2 1 I N D E X TESTIFIERS 2 3 NAME PAGE 4 JENNIFER SMITH, SECRETARY, 5 DEPARTMENT OF DRUG & ALCOHOL 5 DR. RACHEL LEVINE, SECRETARY, 9 6 DEPARTMENT OF HEALTH 7 ELLEN DiDOMENICO, DEPUTY SECRETARY, 17 DEPARTMENT OF DRUG & ALCOHOL 8 SARAH BOATENG, EXECUTIVE DEPUTY SECRETARY, 45 9 DEPARTMENT OF HEALTH 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 3 1 P R O C E E D I N G S 2 * * * 3 REPRESENTATIVE DUNBAR: Good afternoon. 4 We're going to get started. First off, we are 5 ready to start the hearing for DDAP and the Department of 6 Health. 7 Secretary Smith and Secretary Levine, if you 8 could introduce everybody who is with you. 9 SECRETARY JENNIFER SMITH: Sure. Yes. 10 Good morning. This is my Deputy Secretary, Ellen 11 DiDomenico. 12 DEPUTY SECRETARY ELLEN DiDOMENICO: Good 13 afternoon, everyone. 14 SECRETARY RACHEL LEVINE: This is my Executive 15 Deputy Secretary, Sarah Boateng. 16 REPRESENTATIVE DUNBAR: Okay. Anybody who is 17 going to testify, could you please stand and raise your 18 right hand to be sworn in? 19 20 (Witnesses sworn en masse.) 21 REPRESENTATIVE DUNBAR: Please have a seat. 22 As we have been doing, we have been waiving 23 opening statements and getting right to questions, if that's 24 okay with everybody here. 25 SECRETARY RACHEL LEVINE: Yes. 4 1 SECRETARY JENNIFER SMITH: Perfect. 2 REPRESENTATIVE DUNBAR: And as you can tell, 3 Representative Saylor is a bit under the weather so I'm 4 going to be filling in and Representative Gainey is going to 5 help on the other side of the aisle temporarily as well. 6 So our first questions will come from 7 Representative Hahn. 8 REPRESENTATIVE HAHN: Thank you, Chairman. 9 Good afternoon, Secretaries, Deputy Secretaries. 10 Good to see you. 11 Secretary Smith, I'm starting out with DDAP 12 today. 13 SECRETARY JENNIFER SMITH: Sounds good. 14 REPRESENTATIVE HAHN: All right. The Department 15 contracts with the Single County Authorities to provide 16 prevention, intervention, treatment, and recovery-oriented 17 services. Are they required to contract with evidence-based 18 and evidence-informed programs or do they contract with any 19 provider they want to contract with? 20 SECRETARY JENNIFER SMITH: That's a great 21 question. We do contract with 47 different Single County 22 Authorities. Those 47 Single County Authorities represent 23 all 67 counties across the Commonwealth. So they are 24 responsible for doing a localized needs assessment and then 25 strategic plan. And that is across the full continuum of 5 1 care, so in prevention, intervention, treatment, and 2 recovery support services. 3 So over the last several years, we've been moving 4 in the direction of ensuring that our funding is being used 5 for, if not evidence-based, at least evidence-informed 6 programming. So there used to be a wonderful list out on 7 SAMHSA's website that indicated what kinds of programs fell 8 into those categories. 9 SAMHSA changed their perspective a little bit on 10 what that list looked like and had pulled the list down for 11 a little while. So that caused some confusion amongst folks 12 as to what kinds of programs were able to be supported 13 through our Federal funding. But that website is now 14 functional again. It has been restructured a bit. 15 REPRESENTATIVE HAHN: But they're not required -- 16 if a program is not on that list that they're 17 evidence-based, they're not required to contract with them? 18 SECRETARY JENNIFER SMITH: So if those programs 19 are not part of that list, then they would need to seek our 20 approval in order to utilize the funds for that programming. 21 So one of the reasons that we went that route is because 22 there were counties utilizing our funding for programs like 23 scare tactics. And that is not an evidence-based program. 24 And so we have put out some specific guidance around those 25 programs in particular. It doesn't prohibit the Single 6 1 County Authority from utilizing those programs. It 2 prohibits them from utilizing our funding to support those 3 programs. 4 REPRESENTATIVE HAHN: Do the CSAs provide outcome 5 measures to show that the programs are having good outcomes 6 and then to continue or are they required to change if they 7 don't have any evidence-based outcomes? 8 SECRETARY JENNIFER SMITH: Yeah. So they are 9 required to report to us in terms of how many folks they're 10 serving, how many programs they're providing, and the 11 sourcing of all the funding that's being utilized. 12 So we're in the process right now of implementing 13 a new process called a strategic prevention framework, which 14 establishes how they do their needs assessment process, the 15 planning process, the evaluations, and the study of those 16 outcomes. 17 So we've piloted with -- and I don't know the 18 exact number of counties that we've piloted with in terms of 19 implementing that new process. Oh, they're all doing it 20 now. Okay. So all different levels of implementation, but 21 that will be a more stringent requirement in terms of what 22 they're reporting to us without outcomes and justifying the 23 funding that they're using to support the programs. 24 REPRESENTATIVE HAHN: Okay. Is there 25 medication-assisted treatment in all 67 counties? 7 1 SECRETARY JENNIFER SMITH: Yes. Absolutely. 2 REPRESENTATIVE HAHN: Okay. And are they 3 required to provide the same information? Do they do as 4 good a job as any of the other treatments, better, or worse? 5 SECRETARY JENNIFER SMITH: So let me just give a 6 quick clarifying statement. Medication-assisted treatment 7 is not a thing. It's not an entity. It is a type of 8 treatment that can be delivered to individuals who have 9 substance use disorder. So it's really basically just 10 medication that's utilized by some individuals to support 11 their path through treatment and into recovery. 12 REPRESENTATIVE HAHN: But is that -- is there any 13 data as far as like a relapse? So if someone is taking the 14 medicine treatment other than -- is there some type of data 15 that shows that it helps or doesn't help? 16 SECRETARY JENNIFER SMITH: Yeah, there is. I 17 don't have the statistics right at my fingertips. 18 Dr. Levine might. She looked like she was paging 19 through her statistics here. 20 We do have some good information though that has 21 come to us from the Managed Care Organizations who fund our 22 medical assistance clients. We'd be happy to share that 23 data with you. One of the largest entities is CCBH. They 24 cover the bulk of the Commonwealth actually. And they have 25 some pretty interesting statistics in terms of how many 8 1 folks are utilizing medication as part of their treatment 2 regimen and the data does, in fact, show that engagement in 3 treatment is longer for individuals with opioid use disorder 4 who are on some form of medication-assisted treatment. 5 We'd be happy to share that data with you. 6 REPRESENTATIVE HAHN: Okay. Thank you. 7 SECRETARY JENNIFER SMITH: Um-hmm. 8 REPRESENTATIVE HAHN: Secretary, did you have 9 that information? 10 SECRETARY RACHEL LEVINE: Sure. Thank you. 11 I would like to support Secretary Smith's 12 comments about the utility of medication-assisted treatment, 13 sometimes in this case called medication for opioid use 14 disorder, for patients with the disease of addiction to 15 opioids, with opioid use disorder. And so that is really 16 the standard of care as recommended by SAMHSA and Health and 17 Human Services and the Federal Government utilize throughout 18 the states for patients suffering with opioid use disorder. 19 There was a recent article that I wanted to 20 highlight.
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