HHS Unification

Delivering public health, social, and human services to Pennsylvanians in the most efficient and effective way requires innovation, creative thinking, and practical solutions – that’s why Governor Wolf proposed integrating the Departments of Aging, Drug & Alcohol Programs, Health, and Human Services into a new, unified Department of Health & Human Services (HHS).

Over the past several months, Governor Wolf has worked closely with each of these four agencies to identify and break down silos and reimagine how we deliver such critical services. We invite and encourage you to learn more about this initiative by reviewing draft legislation, diving deep into the HHS draft organizational charts, hearing from the prime sponsors in the House and Senate who will propose the legislation that will lead us to the implementation of this new agency, and most importantly weighing in with your own thoughts and ideas. We will continue to update this site as we move through the process.

Why Integrate?

Creating a new, unified Department of Health & Human Services will dramatically improve our ability to deliver services that will improve lives while reducing costs to taxpayers.

Too often, an individual is served by too many different agencies – and we all know navigating the different layers of government can be complex and cumbersome. The following are just a few examples of the key ways an integrated agency can provide an easier way for citizens to interact with the commonwealth and obtain the services they need.

Enhancing our efforts to fight back against the heroin and opioid epidemic

Governor Wolf has led the battle against the heroin and opioid epidemic, and each of these agencies has been critical to this effort. Among many other initiatives, the Department of Health launched a Prescription Drug Monitoring Program and has been raising awareness of the Physician General’s standing order for Naloxone; the Department of Drug & Alcohol Programs has led the effort to increase the availability of Naloxone and drug take-back boxes; the Department of Human Services has created 45 Centers of Excellence to coordinate treatment for those suffering from substance use disorders; and the Department of Aging has led prescription drug take-back efforts among the senior population by encouraging proper use, storage, and disposal of unused prescription medications.

By creating an organization that is structurally better able to support and coordinate these efforts, individuals in desperate need of substance use disorder treatment will be able to access services through one agency with an integrated data and delivery system. The new HHS will serve as the Single State Authority for Medicaid, substance use, and mental health purposes, which will enable the commonwealth to maximize available federal dollars and offset state costs for staff and services.

Additionally, there will continue to be a cabinet-level position in Governor Wolf’s administration that will be dedicated to battling the epidemic.

 

Bolstering senior benefits and programs

Seniors will now have a single point of contact within state government to receive health care services, human services, and long-term services and supports. Instead of obtaining PACE prescription assistance through the Department of Aging, applying for the Aging Waiver through the Department of Human Services, finding out where to dispose of unwanted or expired prescription drugs through the Department of Drug & Alcohol Programs, or searching for information on the quality of nursing homes through the Department of Health, seniors would find all the services they need through HHS.

And, although HHS will now ensure that all senior services are streamlined, older Pennsylvanians will still go to their AAAs when they have questions about these services, just like they do today. However, if a senior needs to call HHS about any of these services, they will go to one bureau: the Bureau of Aging Services.

Furthermore, the creation of this department will have no impact on how Lottery Fund dollars are used to support senior programs. The important services funded through the Lottery will continue.

 

Reducing complexity and confusion for seniors and those with disabilities

Currently, at least 21 separate services across the four agencies provide care for seniors and individuals with physical disabilities. The creation of HHS will eliminate the unnecessary duplication of effort and confusion that currently exists among consumers and their families. The Wolf Administration is dedicated to continuing to provide the same quality services for seniors and individuals with disabilities and will dramatically improve the delivery of services like health screenings, programs allowing individuals to remain in their homes and communities, adult protective services, and home health care and housing supports.

 

Reducing red tape for providers and non-profits subject to regulation

Providers ranging from hospitals and childcare centers to substance use treatment facilities and nursing homes are currently licensed by multiple agencies, often for the provision of the exact same services. Requiring these businesses to subject themselves to multiple, duplicative inspections and audits costs them money. By centralizing facility licensure in one agency we will improve coordination, increase transparency, and promote uniformity for the health and human services field. The state and providers will be able to better focus our resources on our mission to improve the health and quality of life for citizens rather than back office functions.

 

What’s in the legislation?

Draft legislation would amend the Administrative Code of 1929 to establish the Department of Health & Human Services, while repealing existing articles that provided the statutory authority for the Departments of Aging, Drug & Alcohol Programs, Health, and Human Services.

In addition to outlining the typical duties of an agency secretary and Physician General, the draft legislation maintains cabinet-level positions focused exclusively on seniors and substance use and addiction: a Commissioner on Aging and a Commissioner on Substance Abuse and Addiction.

HHS will serve as the single state agency to receive and disburse funds under the Older Americans Act of 1965 and will develop and administer the State Plan for Aging required by federal law, in consultation with the Council on Aging. The department will also provide services to older adults through the Area Agencies on Aging (AAAs). The current requirement that each AAA be held harmless to the amount of commonwealth funds received in the prior fiscal year is maintained.

Like the current Department of Drug & Alcohol Programs, HHS will develop and adopt a state plan for the control, prevention, intervention, treatment, rehabilitation, and research related to substance use disorder and education and training matters.

The draft legislation transfers all the powers and duties of the four existing agencies to HHS, including:

      • Mental health, intellectual disability, autism, substance use disorder, and gambling addition services;
      • Licensing and regulation of facilities and agencies with the primary functions of diagnosis, treatment, care, and rehabilitation of individuals with mental illness, emotional disturbance, intellectual disability, autism, or substance use disorder;
      • Licensing, certification, and regulation of health care facilities and medical marijuana organizations;
      • Certification and regulation of laboratories, emergency medical services providers, and managed care organizations;
      • Public health, disease prevention, newborn screening, and maintenance of vital statistics;
      • Child protective services;
      • Domestic violence and rape crisis services;
      • Controlled substances;
      • Residential substance use disorder treatment programs for women and children;
      • Programs and services for older adults;
      • Home and community-based services

Legislative Prime Sponsors

Republican State Representative Stephen Bloom (Cumberland County) and Democratic Senator Judy Schwank (Berks County) have announced their intent to be the prime sponsors of this bipartisan legislation, and issued a sponsorship memo to their General Assembly colleagues outlining why they agree integrating the agencies would provide such great benefits to the commonwealth:

In the near future, I will introduce the enabling legislation for Governor Wolf’s proposed unification of the Departments of Aging, Drug and Alcohol Programs (DDAP), Health, and Human Services (DHS) into a new Department of Health and Human Services.

In his budget address, Governor Wolf presented this unification not only to achieve savings and efficiencies but, most importantly, to improve the delivery of services to Pennsylvanians. The proposed unification presents us with a significant opportunity to reinvent state government, streamline bureaucracy, and break down the silos that prevent agencies from serving residents most effectively. While all four agencies today are providing high quality services, we can do better by creating a no-wrong-door approach for Pennsylvanians. Examples of the overlap among these agencies abound. The Supplemental Nutrition Assistance Program (SNAP), Women Infants and Children Program (WIC), and Temporary Assistance for Needy Families Program (TANF) are similar in nature and often serve overlapping populations. Many individuals receiving WIC are also receiving SNAP due to the limited types of food and supplies that can be purchased with each. Yet SNAP and TANF are housed in DHS and WIC is housed in the Department of Health. WIC is distributed to individuals by check and SNAP and TANF are distributed on Electronic Benefit Transfer (EBT) cards.

DHS provides home and community based services to certain eligible seniors through the Aging Waiver, while the Department of Aging oversees Pennsylvania’s network of 52 Area Agencies on Aging (AAAs), many of whom provide application assistance and administer service coordination for individuals in the Aging Waiver. Similarly, DDAP licenses drug and alcohol facilities, many of whom operate in the Medicaid program. At the same time, DHS, the Department of Health, and the Department of Aging license various other providers including hospitals, nursing homes, adult day care facilities, personal care homes, and child care facilities. Combining the licensing resources of these four agencies will help to ensure treatment options are available to all those who need them as we continue to battle the heroin and opioid epidemic and grapple with an increasing aging population.

In 2015, the General Assembly and Governor Wolf took a bold step to move the Children’s Health Insurance Program (CHIP) to DHS where it is more appropriately housed as compared to the Insurance Department, an agency whose mission is primarily regulatory. In December 2015, the average time required to process a CHIP claim was 40 days. As of October 1, 2016, that time had decreased to one day. In the same period, approximately 17,000 additional children received health care under the program.

The unification of the current four agencies can allow us to replicate this success into many other areas of service delivery and achieve efficiencies and savings. This legislation is the beginning of a journey to improve the way government does business, a journey in which our input and participation is vital.

I urge you to join me in co-sponsoring this important legislation.

“In a time of limited resources and ever increasing needs for human services, state government must work continually to streamline delivery and reduce costs. The status quo is no longer acceptable.” – Sen. Judy Schwank (D-Berks)

 

“I am willing to work with any governor from any party to implement beneficial reforms like this, to make our state government more efficient and effective in delivering vital services, and to save money for our hardworking taxpayers.” – Rep. Stephen Bloom (R-Cumberland)

 

Organizational Structure

Leadership

Draft legislation establishes or maintains in statute four cabinet-level positions: a Secretary of Health & Human Services, Physician General, Commissioner on Aging, and Commissioner on Substance Use & Addiction.

Secretary of Health & Human Services

Governor Wolf intends to nominate current Pennsylvania Insurance Commissioner Teresa Miller to serve as the inaugural Secretary of Health & Human Services. Miller has served as Insurance Commissioner since January 2015 where she has worked on a range of issues including the administration’s top priorities – fighting the opioid epidemic and helping seniors.

Prior to coming to Pennsylvania, Miller served as acting director of the State Exchanges Group, the Oversight Group, and the Insurance Programs Group in the federal government’s Centers for Medicare and Medicaid Services. Before going to Washington, Miller served as the administrator of the Oregon Insurance Division. Miller received her J.D. from Willamette University College of Law, and her B.A., magna cum laude, from Pacific Lutheran University.

Miller is a national leader on insurance issues that impact consumers. At the National Association of Insurance Commissioners (NAIC), she chairs the Senior Issues Task Force and its Long-Term Care Innovation Subgroup, which is examining the future of private solutions to long term care financing, with a focus on removing barriers to pursue concrete solutions that can pave the way for the private market to play a more meaningful role in financing the long term care needs of society. She is also on the Congressional Budget Office’s panel of health advisers, offering input on the potential impact federal policies and proposed legislation may have on health care consumers.

Standing up for seniors

Teresa Miller has been a leader in the administration’s efforts to protect seniors. Her work to ensure seniors in Western Pennsylvania were protected and would not lose access to their doctors helped prevent disruption in care for 180,000 by ensuring UPMC providers continued participation in Highmark’s Medicare networks.

In 2017, Teresa was named chair of the National Association of Insurance Commissioners (NAIC) Senior Issues Task Force. Also at the NAIC, Teresa has been a leader in taking on the current challenges of the long term care insurance markets. At her request, the NAIC created the Long Term Care Innovation (LTC) Task Force, which she now chairs and which is working to increase long term care funding options for consumers, including increasing the number of affordable asset protection options available.

Teresa has also looked for ways to innovate in long term care insurance in Pennsylvania, making a change to the requirements for long term care insurance policies that will allow lower- priced products to be considered LTC partnership products; products that allow consumers to retain some assets if they need to transition to Medicaid after exhausting their private coverage.

Teresa has taken on the challenge of the long term care insurance market, holding a public hearing to increase transparency into the market and the process by which rates are determined. Teresa feels strongly about keeping long term care insurance consumers informed, and often personally corresponds with consumers impacted by long term care insurance rate increases.

Fighting the heroin and opioid crisis

Under Teresa’s leadership, the department has begun a comprehensive strategy to ensure insurance companies are complying with all laws related to coverage for mental health and substance use disorder treatment. The strategy includes three prongs: increasing consumer outreach and soliciting consumer complaints, reviewing insurance policy forms to ensure they describe proper coverage, and performing compliance audits on all of Pennsylvania’s major health insurers.

In order to enhance consumer awareness and understanding, the Pennsylvania Insurance Department (PID) published new, comprehensive guidance aimed to help consumers understand what mental health and substance use disorder benefits they are entitled to under law based on the type of health insurance they have and to provide them with information on who to call if they experience issues with this coverage.

Teresa received the Ambassador for Recovery Award at the 2016 Recovery Walk in Philadelphia in recognition of her leadership on parity enforcement. This award is organized and presented by the Pennsylvania Recovery Organization-Achieving Community Together (PRO-ACT) and The Council of Southeast Pennsylvania.

While CHIP was still under PID, Teresa ensured children and teens had access to comprehensive substance use disorder treatment by ensuring all CHIP plans complied with Act 106 requirements.

Working with the federal government, Teresa had direct oversight of implementation of parity for the U.S. Department of Health & Human Services, working to make sure parity was effectively implemented across the country.

In Oregon, Teresa fought for state adoption of parity, and represented drug and alcohol treatment providers, disability providers, and social workers.

image of Governor Wolf smiling next to a lab“Commissioner Miller has fought to protect health care for seniors and kids, and embodies the best of public service – effectively working across the aisle and state lines – to make the lives of Pennsylvanians better and more secure.” – Governor Tom Wolf

Commissioner on Aging

The Commissioner on Aging will be tasked with advising the Governor and coordinating commonwealth efforts on issues that impact seniors, and will work with the department to develop the State Plan on Aging and State Plan on Alzheimer’s. The Commissioner will work closely with the Deputy Secretary for Aging & Adult Community Living.

Commissioner on Substance Abuse & Addiction

The Commissioner on Substance Abuse & Addiction will be tasked with advising the Governor and coordinating the efforts of commonwealth agencies in the control, prevention, intervention, treatment, rehabilitation, research, education, and training aspects of substance use disorders and gambling addiction. The Commissioner will work closely with the Deputy Secretary for Mental Health and Substance Use Disorder Services.

Physician General

The Physician General is tasked with advising the Governor and Secretary on health policy, participating in the decision-making process of all state agencies on policies relating to medical and public-health-related issues, and reviewing professional standards and practices in medicine and in public health.

 

Agency Structure

Over the past several months, workgroups comprised of staff from all four agencies, in collaboration with the Governor’s Office, have been hard at work reimagining the ways we deliver critical services. These workgroups examined the current structures in each agency and identified ways to break down silos and enhance their abilities to administer their programs. We think this new employee-driven organizational structure reflects an innovative and pragmatic approach to designing an agency built for the 21st century. Check out the details of each office below for yourself.

Secretary’s Office

The Secretary’s Office in the Department of Health & Human Services consists of different offices and programs that cut across the agency’s ten deputates, working collaboratively to develop policy and executive broad program initiatives. In addition to the Offices of Budget, Communications, General Counsel, Legislative Affairs, and Policy, the Secretary’s Office includes the following offices reporting directly to the secretary:

      • The Office of Community Resources will consist of a free health insurance counseling program (APPRISE) designed to help older Pennsylvanian’s with Medicare; Aging & Disability Resource Centers (ADRC); Adult Protective Services and Older Adult Protective Services; and housing programs that assist with housing coordination among all program offices.
      • The Office of Health Equity will collaborate with state agencies, academic institutions, community-based organizations, health partners, providers and other in the public and private sector to develop and implement policies and programs that result in a measurable and sustained improvement in health status of underserved and disparate populations.
      • The Office of Health Innovation will work to transform the way we pay for, deliver, and coordinate health and health care services by advancing population health, health information technology, and workforce development.
      • The Office of Medical Marijuana will continue to implement the state’s Medical Marijuana Program, which will provide access to medical marijuana for patients with a serious medical condition through a safe and effective method of delivery that balances patient need for access to the latest treatments with patient care and safety.

 

Office of Administration

 

This new office reflects the epitome of unification and elimination of duplicative services and streamlining government by consolidating the front office functions of all four agencies.

In this office, the following programs will be better coordinated and managed:

      • Support Services, such as mail, fleet services, and records management
      • Lease and space management, parking, and surplus inventory
      • Discrimination and Equal Opportunity Activities
      • Hearings and Appeals – there will no longer be four different methods for individuals and providers to exercise their right to appeal departmental decisions
      • Procurement and Contract management
      • Vital Records
      • Audit and cost allocation plans
      • Federal reporting

The coordination and consolidation of these administrative functions and activities will reduce overlapping services and coordinate the process for those who use them, resulting in an improved customer and provider experience and overall functioning of state government.

 

Office of Aging & Adult Community Living

 

In recognition of the growth of Pennsylvania’s aging and aged population, the need to better coordinate care and services at an affordable cost for some of our most vulnerable citizens is greater than ever. Through the creation of a unified HHS, the commonwealth will enhance and allow for the expansion of home and community-based services in ways not realized today, with a continuity of care available regardless of which service is needed. Programs providing consumer-driven supports and services in one unified agency will streamline access while lessening confusion for seniors, their families, and providers.

In this office, the following programs will be better coordinated and sustained:

      • Care Transitions & Nursing Home Transitions
      • OPTIONS
      • Housing programs for seniors
      • Programs provided under the Older Americans Act
      • Community HealthChoices
      • Attendant Care and Act 150
      • Aging Waiver
      • OBRA, Independence, & COMMCARE Waiver
      • Education & outreach
      • Nursing facilities
      • Metrics & analytics
      • AAA Network
      • LIFE
      • Enrollment & assessment

The Governor’s proposed budget includes the implementation of Community HealthChoices, which will better coordinate health care coverage and long-term care services and supports to serve over 420,000 older Pennsylvanians and individuals with disabilities in communities rather than facilities. Community HealthChoices implementation will begin in the Southwest on January 1, 2018. Long-term oversight for Medicare and Medical Assistance (dual eligible) will now be under a single agency, improving service delivery and consumer experience.

No additional Lottery Fund dollars are transferred to offset General Fund expenditures as part of the unification and Lottery Fund revenues will continue to be solely dedicated to support senior programs.

The continuity of services for older adults will be further realized through the ongoing use of lottery dollars to support Older Americans Act programs, senior community center grants, and the State Plan on Alzheimer’s Disease and related disorders.

 

Office of Child Development & Early Learning

 

While this reflects no change in structure related to the unification, it is important to highlight the important programs provided by this office.

In this office, the following programs will continue:

      • Administration of the federal Child Care Development Block Grant (CCDBG)
      • Child Care Works
      • Keystone STARS
      • Community Based Family Centers
      • Maternal and Infant Home Visiting programs
      • Pre-K Counts and Head Start Supplemental
      • Early Intervention for children ages 0-5
      • Professional Development for early education providers
      • Certification and licensing for child care centers, group child care homes, and family child care homes

The Governor’s proposed budget includes the following initiatives related to these programs:

      • $9 million in increased funding for the expansion of Evidence Based Home Visiting to support the enrollment of an additional 1,700 children and their families into home visiting programs and reduce the number of days an eligible family must wait for services
      • $10 million in increased funding to serve an additional 1,800 children from the child care subsidy waiting list enabling their parents to work
      • $75 million in increased funding to serve an additional 8,400 children in Pre-K Counts and Head Start programs
      • $21.9 million to continue to serve over 38,000 children who need Early Intervention services

 

Office of Children, Youth, & Families

 

While this reflects no change in structure related to the unification, it is important to highlight the important programs provided by this office.

In this office, the following programs will continue:

      • Operation of the Youth Development Center/Youth Forestry Camp System
      • Safe Haven
      • ChildLine
      • Mandatory Reporter Training
      • Supervision and Oversight on the County Children and Youth Agencies
      • Fiscal Policy and regulations related to these programs
      • State Wide Adoption Network and Foster Care

This office supports the county-administered social services program for children and youth in each of the commonwealth’s 67 counties, as required in the County Code and the Human Services Code. Services are provided to dependent and delinquent children, as well as those needing prevention and/or intervention services, and their families. Eligibility for service is based on each child’s need for service as determined by the county Children and Youth Agency and the Juvenile Probation Office. While services are provided without regard to income, the county children and youth agencies may establish fee scales based on a family’s ability to pay to offset program costs. Services are provided to children in their own homes and if necessary, in out-of-home placements.

Many children awaiting adoption have special needs that make it difficult to find adoptive homes. In Fiscal Year 1992-1993, the SWAN Program was established to place children with special needs in permanent homes. SWAN serves children in the custody of a county children and youth agency that may or may not have a goal of adoption in order to help them achieve permanency, whether that permanency is reunification, adoption, permanent legal custodianship, or placement with a fit and willing relative. Funds are provided in the Governor’s Executive Budget for Fiscal Year 2017-2018 to provide family recruitment services, adoptive placement services, post-adoption services, legal services, and adoption training. As of September 30, 2016, Pennsylvania has 2,762 children in foster care with a court-ordered goal of adoption.

The Governor’s Executive Budget includes $44 million in increased funding for the county needs-based budget as mandated by Act 30 of 1991.

 

Office of Developmental Programs

While this reflects no change in structure related to the unification, it is important to highlight the important programs provided by this office. The mission of the Office of Developmental Programs, which remains the same, is to support Pennsylvanians with developmental disabilities to achieve greater independence, choice, and opportunity in their lives. The office seeks to continuously improve an effective system of accessible services and supports that are flexible, innovative, and person-centered.

In this office, the following programs will continue:

      • Operation of the State Centers
      • Intermediate Care Facilities
      • Intellectual Disabilities Community Base Program – County Grants
      • Intellectual Disabilities Community Waiver
      • Adult Autism Waiver
      • Adult Community Program
      • Professional Training
      • Program Data and Analytics

The Governor’s proposed budget includes $26.5 M in additional funding to serve more people in the community and strengthen our support for adults with intellectual disabilities and autism. Specifically, the budget initiative:

      • Moves 1,000 individuals from the waiting list into services
      • Establishes a new intermediate Community Support waiver for individuals with ID and Autism
      • Expands the PFDS Waiver for 820 special education graduates with ID and Autism
      • Expands the Adult Autism Waiver by 50 individuals
      • Expands the Targeted Services Management State Plan to include 2,000 individuals and Autism and ID
      • Funds the transition of 40 individuals from state centers to the community
      • Establishes two Bio-Behavioral Units to support individuals with ID and Autism who have neuro-behavioral issues

 

Office of Eligibility & Self-Sufficiency

 

The commonwealth currently operates 96 local County Assistance Offices (CAOs), which are the primary point of contact to access services, support transition to economic self-sufficiency, and help with vital human services. Currently, the CAOs are responsible for the financial eligibility determination of applicants and redetermination of eligibility for recipients of:

      • Temporary Assistance for Needy Families (TANF) cash assistance
      • Low Income Home Energy Assistance Program (LIHEAP)
      • Medical Assistance (MA)
      • Supplemental Nutrition Assistance Benefits (SNAP) Food Stamps

As part of the unification and creation of this office, CAOs will now be the point-of-access for financial eligibility determination for applicants and redetermination of eligibility for recipients of the above programs, as well as:

      • Pharmaceutical Assistance Contract for the Elderly (PACE) and PACENET
      • Women, Infants, & Children (WIC)

Other services and programs administered in this office are:

      • Child Support Enforcement
      • Homeless Assistance & Emergency Shelter
      • Employment Training

As part of the Governor’s proposed budget, the redesign of the CAOs will be managed within this office. Back office functions of CAOs will be consolidated by shifting these functions to processing centers to reduce the physical footprint of CAOs starting with the highest staff turnover. (A similar model was established in 2016 by shifting high turnover rate jobs at the Dauphin County CAO to a back office processing center in Cambria County.)

No CAO would be eliminated and offices and staff would remain in all counties to ensure access to individuals seeking services, assistance, and face-to-face customer service.

 

Office of Health Care Quality & Licensure

 

This new office coordinates the licensure programs that are currently administered by multiple state agencies, sometimes for the provision of the same services.  Often providers are subject to multiple inspections and audits and the resulting bureaucracy impedes their ability to provide adequate services. A consolidated structure provided in this office will reduce bureaucratic hurdles, provide clearer and more cohesive guidance to providers, save taxpayer dollars, and give providers the opportunity to spend more time delivering quality services to Pennsylvanians in need.

In this office, licensing programs will be administered for the following facilities:

      • Nursing Facilities
      • Home Care Agencies
      • Personal Care Homes
      • Assisted Living Residences
      • Intermediate Care and Intellectual Disability Facilities
      • Home Health Agencies
      • Federally Qualified Health Centers
      • Renal Dialysis Centers
      • Hospitals
      • Psychiatric Hospitals
      • Abortion Facilities
      • Older Adult Daily Living Centers

In this office, the following quality assurance programs will be administered in order to improve regulatory oversight and protection for vulnerable populations:

      • Program Integrity and Third Party Liability Review
      • Certification and Quality Review of Managed Care Organizations
      • Regulatory Implementation and Safety Inspection
      • Professional Development

 

Office of Medical Programs & Pharmacy Services

 

The commonwealth currently operates several programs that provide health insurance coverage as well as several different pharmaceutical programs that offer coverage to different populations based on eligibility criteria.  The programs are spread across the Department of Aging (PDA), the Department of Health (DOH) and the Department of Human Services (DHS).  In some cases several programs use the same mechanism or drug contract to deliver the coverage, but have to go through a cumbersome Memorandum of Understanding process to allow that to occur.  The unification of these agencies and the creation of HHS will allow a much more coordinated effort with reduced red tape and streamlined delivery.

In this office, the following health insurance programs will be better coordinated:

      • Medical Assistance (MA) Fee for Service model
      • Medical Assistance Managed Care
      • Children’s Health Insurance Program (CHIP)

In 2016, the CHIP moved from the Department of Insurance to DHS.  This transfer resulted in an increase in the number of insured kids, improved customer service and better coordination with MA, which also saved the commonwealth $8 million annually.

In this office, the following pharmaceutical programs will be better coordinated:

      • CHIP
      • MA Fee for Service model
      • Pharmaceutical Assistance Contract for the Elderly (PACE) and PACE NET
      • Chronic Renal Dialysis Program

This consolidation lays the groundwork for further integration of pharmacy functions throughout other commonwealth programs that have been spread across multiple agencies.

As part of the Governor’s proposed budget, the dispensing fee structures of MA Fee for Service and PACE/PACENET will be aligned to achieve a savings of $45M.

      • The original proposal was to reduce the current dispensing fee from $13 to $4. Since the printing of the budget book, a study was released by Mercer on behalf of DHS as part of compliance with the Medicaid Outpatient Drug Rule and a new target of $7 dispensing fee was set based on that survey.
      • An independent review was conducted by PFM and they were able to validate that reducing this dispensing fee would result in a savings to the Lottery Fund and subsequently the General Fund by a range of $38M-$55M.

 

Office of Mental Health & Substance Use Disorder Services

 

This new office will improve the capacity of and coordination among mental and behavioral health and substance use and addiction programs to provide more efficient, integrated services and systems for Pennsylvanians struggling with one or more related conditions.

Under this office, the following programs will be better coordinated:

      • Licensure, oversight, and coordination of Single County Authorities (SCAs), drug and alcohol, mental health, and behavioral health providers
      • Oversight of Centers of Excellence and Pennsylvania Coordinated Medication Assisted Treatment (PacMAT) providers including data collection and output
      • Professional Training and Development
      • Access to care for special populations such as those with co-occurring mental/behavioral health and substance use disorders, dual diagnosis, older adults, children and youth, LGBTQ individuals, veterans, and those with gambling addition
      • Housing and transition services for those in recovery
      • Prescription Drug Monitoring Program (PDMP) and prescribing guidelines
      • 21st Century CURES Act grant management andprograms

The Governor’s proposed budget includes federal funding from the 21st Century CURES Act in the amount of $26.5 M for Fiscal Year 2017-18. The application for the funds was a collaborative effort among DHS, DDAP, DOH, Aging, and the PA Department of Education. The new HHS structure will enable the funds to be distributed to the local level in an expedited manner and will better coordinate the many programs slated to be supported with the grant funds, as well as the required needs assessment that will evaluate the effectiveness of the programs. The funds will be used to:

      • Increase access to treatment, including Medication Assisted Treatment (MAT), with a specific emphasis on individuals who are under or uninsured,
      • Reduce unmet treatment need, and
      • Reduce overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder.

Also included as part of the Governor’s proposed budget is a $20.4 M investment in the FY2016-17 initiative that created 45 Centers of Excellence to improve treatment outcomes for individuals with opioid use disorder. The FY2017-18 request seeks to annualize these dollars and provide a stable funding source for the Centers of Excellence going forward. In addition, as these Centers are licensed by DDAP but run out of the DHS, the new HHS structure will enable greater oversight and coordination of services and data collection among these Centers, which serve as critical patient-centered hubs that coordinate physical and behavioral health care for individuals with opioid use disorder in counties throughout the commonwealth.

 

Office of Public Health

 

This new office includes many of the programs and services that are currently administered and operated by the Department of Health (DOH), but better coordinates and eliminates duplicative services that are delivered by several departments across the four agencies that make up the new, unified Department of Health and Human Services. Through the use of community-based strategies, this office will continue to focus on reducing the number of serious illnesses, injuries, and deaths due to major health threats; tobacco-related diseases; infectious disease; and, accidental injuries.

In this office, the following programs will continue to be administered (this is not an exhaustive list):

      • Communicable Disease treatment and prevention such as HIV, TB, and STDs
      • Immunizations
      • Emergency Medical Services and Preparedness
      • Operation of State Health Center programs and coordination with local and school health departments
      • Newborn screenings
      • Community Health Education and Outreach
      • Health Professionals Development
      • Lead Hazard Control Program
      • Women, Infant, and Children (WIC) programming (note: WIC eligibility will shift to the Office of Eligibility and Self Sufficiency)
      • Maternal Child Health (MCH) Block Grant and MCH Workforce Development

Certain functions currently coordinated through DHS’s Office of Social Programs (OSP), including family planning, Real Alternatives, rape crisis, and domestic violence prevention grant management, will move into this office in order to better coordinate services, information, and counseling on health care for women, men, and teens throughout the commonwealth.

As part of the Governor’s proposed budget, the current structure of the State Health Centers will undergo a change to modernize the delivery of services by these entities:

      • Currently, DOH operates 55 state health centers (SHC) that provide clinical services for uninsured and underinsured Pennsylvanians
      • The proposed modernization reduces brick-and-mortar health centers and relocates them into community-based settings to increase regular participation and provide enhanced service and education for the consumers.
      • A new centralized delivery model will focus on efforts to refer individuals to available programs where they will receive the most cost-efficient and effective services and reduces costs by $15 million, annually.

 

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