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Staff Shortages, ‘Burdensome’ Regulations Among Top Hurdles for Addiction Treatment Providers


by Cassie Miller, Pennsylvania Capital-Star
March 9, 2023

Lawmakers in Harrisburg heard about the challenges substance use treatment providers, community leaders, and law enforcement are facing in their efforts to combat addiction at a legislative hearing on Thursday. 

At the three-hour-long public hearing hosted by the Center for Rural Pennsylvania, a bipartisan and bicameral legislative agency, panelists provided lawmakers with an update on various efforts to stem the tide of opioid addiction and prevent overdose deaths in the commonwealth. 

Panelists also urged legislators to remove or reform what they called “burdensome” regulations that create unnecessary barriers to care for those seeking treatment. 

Justin Wolford, director of outpatient services at Cen-Clear Child Services, which employs more than 700 people across Pennsylvania, said that while demand for treatment services has increased, the ability of providers to accept new clients has been held down by regulations governing state licensures for providers and staff-to-patient ratios.

Under the Wolf administration, the Department of Drug and Alcohol Programs (DDAP) outlined new licensure expectations for facilities and treatment providers. The agency was initially granted oversight of the facilities through a 2017 state law

Wolford said that he hoped that policy makers would consider reforming “regulations that specifically outline requirements for staff-to-client ratios that may not align with the reality of the Commonwealth’s current need or its capacity to treat this population.”

Wolford also said that “low wages, concerns regarding irregular hours, paperwork demands, and a desire for exclusively remote work” have contributed to staffing shortages that are exacerbated by state licensure requirements. 

“While we can offer some flexibility in these regards, the rurality of our service areas often comes with limited access to broadband, unreliable cell phone services, or the general inability to afford the equipment necessary to reliably access services in an exclusively remote capacity,” Wolford said.  

Because Cen-Clear is unable to compete with other non-Medicaid-reliant entities, workers ultimately “take their valuable skills elsewhere.”

“While many entities are able to adjust their pay to attract qualified candidates, agencies functioning largely on Medicaid reimbursement struggle not only to offer the fringe benefits seen in other agencies, but with rates that are deemed competitive, as well,” Wolford said. 

Jason Snyder, director of the behavioral health division of the Rehabilitation and Community Providers Association, echoed Wolford’s comments about the impact of the workforce shortage. 

“Addiction treatment providers’ current inability to fill open positions as a result of an unprecedented workforce crisis and the ill-timed mandate by DDAP to implement a new treatment system framework have not only weakened the treatment system’s ability to meet demand for services, but worse, have forced providers to turn patients away despite having capacity to treat them,” Snyder said. 

Snyder called on lawmakers to “compel” the DDAP secretary to address staffing and licensure concerns in the short-term and policy reforms in the long-term.

“Our problem today is not capacity related,” Snyder said. “Outpatient facilities operate at a fraction of their previous, or necessary, capacity. At our opioid treatment programs, where we provide evidence-based, FDA-approved medication that is proven by research and data to reduce overdose deaths, providers are expected to turn away those who seek help, even if the provider has capacity on its license, if the counselors currently employed there would have to take on a higher caseload than regulations allow, because the provider can’t hire enough counselors in this workforce crisis.” 

Lawmakers questioned panelists about whether Pennsylvania state officials and community stakeholders were implementing a preventative approach to fighting the opioid epidemic or if statewide efforts were operating on the defense. 

“Are we just playing a reactive game and we need to go to a proactive game?” state Rep. Dan Moul, R-Adams, asked, “We’ve been talking about this issue since the day I came in and I’ve been here 17 years.”

Jeff Hanley, executive director at the Commonwealth Prevention Alliance, responded that implementing evidence-based programming takes time, but agreed that more needs to be done to “get upstream” of the epidemic. 

Hanley suggested expanded preventative education in public schools, including teaching coping skills and “resiliency.” Hanley said that one-time speakers and scare tactics in schools aren’t an effective way to inform children about substance use disorder and opioids. 

State Sen. Gene Yaw, R-Lycoming, concluded that “it sounds like we’re [state government] more concerned with paper work.”

Pennsylvania Capital-Star is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Pennsylvania Capital-Star maintains editorial independence. Contact Editor John Micek for questions: Follow Pennsylvania Capital-Star on Facebook and Twitter.