Regular Session 2021-2022 Senate Resolution 0352 P.N. 1964

PRINTER'S NO. 1964

THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE RESOLUTION

No.

352

Session of

2022

INTRODUCED BY BROOKS, OCTOBER 11, 2022

REFERRED TO HEALTH AND HUMAN SERVICES, OCTOBER 11, 2022

A RESOLUTION

Directing the Joint State Government Commission to study and

issue a report on the specific data, calculations and

mechanisms that the Department of Human Services utilizes to

determine the amount of Medical Assistance capitation funding

that is ultimately paid to drug and alcohol addiction

treatment providers within this Commonwealth.

WHEREAS, This Commonwealth is among the top 10 states with

the highest drug overdose death rate in this country, with

approximately 42 deaths per 100,000 citizens recorded in the

year 2020; and

WHEREAS, In 2021, at least 15 Pennsylvanians died each day

due to a drug overdose; and

WHEREAS, The rate of drug overdose deaths and the need for

drug and alcohol addiction treatment has increased in recent

years due to the increased availability of fentanyl and

xylazine; and

WHEREAS, The cost of providing drug and alcohol addiction

treatment services has also increased due to workforce

challenges exacerbated by the COVID-19 pandemic and heightened

supply costs due to inflation; and

WHEREAS, The increased demand for addiction treatment

services is directly impacting this Commonwealth's health care

system, in which acute care hospitals are unable to find

available settings to discharge patients or to transition

patients to postacute care or treatment facilities; and

WHEREAS, The unprecedented demand for mental and behavioral

health services post-COVID-19 pandemic has been echoed by

increased rates of attempted and completed suicides among youth

and young adults and individuals with substance use disorders;

and

WHEREAS, This Commonwealth's reimbursement for drug and

alcohol addiction treatment services is complex and includes:

(1) The Department of Drug and Alcohol Programs, which

administers the Substance Abuse Prevention and Treatment

Block Grant.

(2) The Department of Human Services, which pays for

Medicaid-covered services.

(3) The 47 administrative entities called Single County

Authorities, which utilize county and block grant funding to

reimburse services for those not covered by Medicaid.

(4) The Behavioral HealthChoices managed care

organizations that contract with a county to coordinate the

delivery of Medicaid-covered services through a network of

drug and alcohol addiction treatment providers;

and

WHEREAS, Financing drug and alcohol addiction treatment and

care coordination is complex, and it is unclear how funding

allocated to these programs by the General Assembly is being

directed toward reimbursing providers that support increasing

access to care and making quality-based program improvements;

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and

WHEREAS, Medicaid spending increases each year, requiring the

Department of Human Services to make annual supplemental

appropriation requests to cover program costs; and

WHEREAS, These drug and alcohol addiction treatment providers

have not seen rate increases consistent with expanding demands;

therefore be it

RESOLVED, That the Senate direct the Joint State Government

Commission to study the specific data, calculations and

mechanisms that the Department of Human Services utilizes to

determine the amount of Medical Assistance capitation funding

that is ultimately paid to drug and alcohol addiction treatment

providers within this Commonwealth, including:

(1) explaining the allocation of funding distributed by

the Department of Human Services to the county and from the

county to the county's contracted Behavioral HealthChoices

managed care organization;

(2) determining the process that the Department of Human

Services utilizes to collect cost-reporting data from drug

and alcohol addiction treatment providers and the extent to

which the cost-reporting data and other information,

including, but not limited to, the following, are used to

determine reimbursement rates:

(i) increases in the general cost of living;

(ii) inflation;

(iii) capital depreciation and amortization costs;

(iv) workforce and salary demands;

(v) regional differences; and

(vi) other information that the commission finds

relevant in the calculation that informs the Medicaid

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capitation allocation;

(3) at a county level, confirming the information and

data that informs the amount of county funding that is

allocated to a county's Single County Authority; and

(4) at the managed care organization level, using data

from fiscal year 2019 as a reference:

(i) determining the portion of the organization's

capitation funding that was used to reimburse drug and

alcohol addiction treatment providers for services

provided;

(ii) reporting anonymized provider-level data on the

percent change in provider reimbursement rates over the

previous fiscal year; and

(iii) reporting on the policies and mechanisms of

managed care organizations to afford providers a

meaningful opportunity to negotiate reimbursement rates

that account for increased demand for services and

quality improvements;

and be it further

RESOLVED, That the Joint State Government Commission be

authorized by the General Assembly to discuss proprietary

information with the Department of Human Services' actuary in

pursuit of this study; and be it further

RESOLVED, That the Joint State Government Commission issue a

report of the findings, along with any statutory or regulatory

recommendations, within seven months of the adoption of this

resolution to the:

(1) Chair and minority chair of the Appropriations

Committee of the Senate.

(2) Chair and minority chair of the Appropriations

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Committee of the House of Representatives.

(3) Chair and minority chair of the Health and Human

Services Committee of the Senate.

(4) Chair and minority chair of the Human Services

Committee of the House of Representatives.

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