Updates

Effective Monday, March 6, 2020, Governor Carney issued a tenth modification to his emergency declaration. Under the modified declaration:

Pursuant to the authority provided in 20 Del. C. § 3116(a)(2), requirements for the provision of telemedicine and telehealth under Title 24 of the Delaware Code that require both audio and visual technology are suspended, which will allow the use of non-smart phone or landline connections.

READ FULL DECLARATION

The Department of Health and Social Services (DHSS) is announcing that all walk-in access to its public offices will end beginning on Monday, April 6, 2020, because of the potential risk for clients and DHSS employees in having in-person interactions. Client needs will now be met in person by appointment only, or through phone, email or online interactions, except for crisis services, emergency cases, or for people without phone or computer access.

“To keep both our clients and our employees safe, this is the right move for our department and for the clients we are committed to serving every day,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “With widespread community transmission in Delaware, it is a public health risk to have our usual in-person interaction. Our offices will have signs on the doors to explain how staff can be reached if clients have an emergency, or for those who don’t have immediate access to a phone or computer.”

Outreach efforts across DHSS, such as the Division of Substance Abuse and Mental Health’s Mobile Crisis Services, the Division of Social Services’ Community Partner Support Unit and the Office of Animal Welfare’s animal control services are continuing. Appointments through DSAMH already scheduled are still expected to occur through telehealth or in person as needed. Admissions and discharges to DHSS’ 24/7 facilities also will continue as needed.

To screen or apply for many DHSS services, Delawareans are encouraged to use DHSS’ online portal, ASSIST. Seniors and individuals with disabilities can also visit the Delaware Aging and Disability Resource’s website or call 1-800-223-9074. For other services (by division), here is how clients and potential clients can make inquiries:

Division of Social Services (Medicaid, SNAP, TANF, General Assistance, Purchase of Care subsidized child care)

Screen for and apply for benefits: ASSIST website, call 1-866-843-7212 or your local officeState Service Center

Customer service (issues with existing benefits): 1-866-843-7212

To make an appointment: Call you local State Service Center

Division of Child Support Services

Customer service or to make an appointment: 302-577-7171

More Information: https://www.dhss.delaware.gov/dhss/dcss/

Division of State Service Centers

Screen for and apply for benefits: ASSIST website or call your local State Service Center

To make an appointment: Call your local State Service Center

Division of Medicaid and Medical Assistance

Screen for and apply for benefits: ASSIST https://dhss.delaware.gov; or 1-800-372-2022 to make an appointment

Health Benefit Manager: 1-800-996-9969

Managed Care Member Service

Highmark Health Options: 1-844-325-6251

AmeriHealth Caritas Delaware: 1-844-211-0966

Long-Term Care Medicaid: apply using ASSIST https://dhss.delaware.gov or 1-866-940-8963

Division of Substance Abuse and Mental Health (crisis, emotional support, services)

Appointments: HelpIsHereDE.com or 1-800-652-2929

Customer service (issues with existing services): 1-855-649-7944

Admissions and Payments: 302-255-9458

Division of Developmental Disabilities Services

Apply for services or to make an appointment: 302-744-9700 or 1-866-552-5758, Option 2

Eligibility appeals: 302-744-9628

Customer service (issues with existing benefits): Call your case manager

Division for Services for Aging and Adults with Physical Disabilities

For all questions, referrals, and access to your existing case manager: Delaware Aging and Disability Resource Center http://delawareadrc.com/ or call 1-800-223-9074

Division of Public Health (Women, Infants, and Children – WIC, immunizations, HIV/AIDS, TB, Health Care Connection, Office of Animal Welfare, etc.)

Apply for or seek services: Call your local Division of Public Health office

To make an appointment: Call your local Division of Public Health office

Office of Animal Welfare’s Delaware Animal Services (animal-related concerns): 302-255-4646

Division for the Visually Impaired

Apply for services, make an appointment or customer service: 302-255-9800 or your case manager

Division of Health Care Quality

Office of Health Facilities Licensing: Hotline:1-800-942-7373; office: 302-292-393

Office of Long-Term Care Resident’s Protection: Hotline:1-877-453-0012; Background Check Center: 302-421-7405; CNA Registry: 302-421-7403

Division of Health Care Quality Customer Service: 302-421-7400

DHSS Constituent Relations

If you have trouble reaching any division or have an issue with your benefits or services being delayed or denied, please reach out to our Constituent Services: dhssinfo@delaware.gov

Also starting Monday, the Department of Health and Social Services and the Division of Public Health will begin a new collaboration with the United Way of Delaware to better triage incoming calls related to COVID-19. Anyone with a question about COVID-19 should call Delaware 2-1-1, 1-800-560-3372, 7-1-1 for individuals with a hearing impairment, or text your ZIP code to 898-211. Delaware 2-1-1 has increased its hours, added operators, and now is available seven days a week to serve Delawareans. For the latest coronavirus updates in Delaware, go to: de.gov/coronavirus

Today the American Society of Addiction Medicine (ASAM) released a focused update to its National Practice Guideline for the Treatment of Opioid Use Disorder (NPG), which provides the latest information on evidence-based treatment of opioid use disorder (OUD) to guide clinicians in assessing, diagnosing, and treating OUD in the United States. The NPG––intended to inform and empower clinicians, health system administrators, criminal justice system administrators, and policymakers who are interested in implementing evidence-based practices to improve outcomes for individuals with OUD––is especially critical in the context of the ongoing COVID-19 emergency, which threatens to curtail patient access to evidence-based treatment.

The NPG unveiled today seeks to both increase the quality of care and access to care for Americans living with OUD––a treatable, chronic disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. The document is an update to the previous NPG released in 2015 and includes major revisions to 35 existing recommendations, along with the addition of 13 new recommendations. This focused update was developed over the course of 14 months with consensus from an independent committee of experts and the use of a rigorous RAND/RAM methodology facilitated by researchers from Research Triangle Institute (RTI).

“As the leader in addiction medicine practice guidelines and resources, ASAM continually monitors new scientific advancements and understandings of OUD—as well as the latest evidence-based treatment approaches––so that we can empower decision-makers to care forthe estimated 2 million Americans living with the disease,” said Paul H. Earley, MD, DFASAM, president of ASAM. “During the ongoing COVID-19 pandemic, and the associated need for social distancing, it is especially important that clinicians and healthcare providers across the country take steps to ensure that individuals with OUD can continue to receive evidence-based care.”

The NPG is the first set of guidelines to address all currently FDA-approved medications available to treat OUD and opioid withdrawal, including all available buprenorphine formulations, in a single document. By understanding and using these guidelines, clinicians will gain confidence in providing effective, evidence-based care for patients with OUD in diverse settings.

“With today’s updated National Practice Guideline, we hope to empower clinicians and policymakers to adopt the best practices and latest advancements in evidence-based care for opioid use disorder,” said Kyle Kampman, MD, FASAM, the Chair of the Guideline Writing Committee. “The research is clear, providing methadone or buprenorphine, even without psychosocial treatment, reduces the patient’s risk of death. Ultimately, keeping patients with the disease of addiction alive and engaged to become ready for recovery is absolutely critical in the context of the deadly overdose epidemic that has struck communities across our country. This guideline is designed to do just that.” ,

While the NPG is ultimately directed at healthcare providers, policymakers and other key stakeholders should note that laws, regulations, and policies may need to change to better support implementation of the evidence-based best practices outlined in the document—especially given the current COVID-19 crisis that is significantly impacting the United States. For example, if a patient cannot access psychosocial treatment because he or she is under some form of isolation or have other risk factors that lead them to want to minimize external interactions, then clinicians should not delay initiation of medication for the treatment of addiction. Expanding the use of telemedicine might also be appropriate for many patients.

The NPG also supports access to all FDA-approved medications for all individuals, including those in the criminal justice system in need of addiction treatment. New policies or regulations may be helpful for facilitating access to medications, particularly methadone, in diverse settings.

All of the updated recommendations are designed to both improve the quality and consistency of care and reduce barriers to access to care for Americans living with OUD. The updated recommendations aim to support initiation of buprenorphine treatment in the emergency department and other urgent care settings. For example, note that all assessments do not need to be completed before initiating pharmacotherapy for OUD. In addition, they provide greater flexibility on dosing during the initiation of buprenorphine treatment and for initiation of buprenorphine at home (which is also an important change in the midst of the COVID-19 crisis).

This comprehensive NPG also includes specific recommendations for special populations. Among the most notable changes related to these special populations are:

• For pregnant women with OUD, treatment with either methadone or buprenorphine is the current standard of care.

• For individuals with co-occurring OUD and pain, temporarily increasing the dose or dosing frequency of methadone or buprenorphine (i.e. split dosing to maximize the pain-relieving properties of these medications) may be effective for managing pain. Moreover, discontinuation of methadone or buprenorphine before surgery is not required.

• Individuals with OUD within the criminal justice system should receive the same standard of care as individuals treated in the community. This means that all existing medications for treating OUD should be available and that patients with OUD should be allowed to maintain their current medications or should be initiated on medication while in the criminal justice system.