Med­i­caid drug re­im­burse­ment to put more fo­cus on coun­sel­ing

Baltimore Sun - - AROUND THE REGION - By An­drea K. McDaniels am­can­diels@balt­sun.com twit­ter.com/ankwalker

The state will change the way it re­im­burses med­i­cal providers for drug re­ha­bil­i­ta­tion un­der Med­i­caid, the in­sur­ance pro­gram for low-in­come peo­ple, to en­cour­age more coun­sel­ing ser­vices for ad­dicts and em­pha­size its im­por­tance as part of treat­ment.

The De­part­ment of Health and Men­tal Hy­giene an­nounced Tues­day that it will re­im­burse for out­pa­tient coun­sel­ing sep­a­rately from methadone treat­ment be­gin­ning next March, open­ing the door for more pa­tients to get coun­sel­ing.

It will also al­low the state to bet­ter track whether treat­ment cen­ters are pro­vid­ing coun­sel­ing.

The cur­rent re­im­burse­ment model for methadone treat­ment lumps drug dis­burse­ment and coun­sel­ing into one cat­e­gory. A clinic is re­im­bursed a sin­gle weekly fee for a pa­tient no mat­ter the num­ber of coun­sel­ing ses­sions they at­tended, methadone treat­ments they re­ceived or other ser­vices they used.

Research has shown the best treat­ment for ad­dicts is a com­bi­na­tion of coun­sel­ing and the use of methadone or buprenor­phine, med­i­ca­tions used to wean peo­ple off heroin and other nar­cotics with­out caus­ing them to feel high or suf­fer painful with­drawal symp­toms, state health of­fi­cials said.

“All the data sug­gests those to­gether are the se­cret sauce to get­ting folks on the path to re­cov­ery,” said Shan­non M. McMa­hon, deputy health sec­re­tary in charge of Med­i­caid.

“We know that we don’t have a great way of mea­sur­ing whether or not peo­ple are get­ting coun­sel­ing and the ac­tual drug at the same time.”

The Be­hav­ioral Health Ad­min­is­tra­tion, which over­sees the pub­lic men­tal health and sub­stance abuse sys­tem for the state health de­part­ment, rec­om­mended in De­cem­ber that re­im­burse­ment be split and Med­i­caid payments for methadone treat­ment be re­duced from $81.60 per week to $42 per week.

Med­i­caid is the fed­eral health in­sur­ance pro­gram for low-in­come adults ad­min­is­tered by the state. Med­i­caid re­im­burse­ments, funded by both the state and fed­eral gov­ern­ment, are used to pay doc­tors, treat­ment cen­ters, hos­pi­tals and other providers for health ser­vices for these res­i­dents.

The re­im­burse­ment pro­posal prompted a flurry of crit­i­cism from drug treat­ment cen­ter op­er­a­tors who said it would slash their rev­enue and leave small clin­ics vul­ner­a­ble to clos­ing.

To ad­dress those con­cerns, the fi­nal pro­posal calls for pay­ing the cen­ters $63 per week for methadone treat­ment, McMa­hon said.

Drug treat­ment cen­ter op­er­a­tors also said that not all clin­ics have the staff and re­sources to pro­vide in­ten­sive coun­sel­ing and not all pa­tients are open to coun­sel­ing right away. Forc­ing them into in­tense ses­sions can prove coun­ter­pro­duc­tive, they said.

A rep­re­sen­ta­tive for the Mary­land chap­ter of the Amer­i­can As­so­ci­a­tion for the Treat­ment of Opi­oid De­pen­dence said they are glad the state made some ad­just­ments to the pro­posal but said the new rules would still be prob­lem­atic for some treat­ment cen­ters.

“It is go­ing to be a dif­fi­cult tran­si­tion for some pro­grams,” said Mar­ian Cur­rens, the group’s pres­i­dent and as­so­ciate med­i­cal di­rec­tor at the Cen­ter for Ad­dic­tion Medicine in Bal­ti­more. “You have to have a ma­jor billing in­fras­truc­ture in or­der to get re­im­bursed.”

Cur­rens and oth­ers said they sup­port the in­tent of the changes to get ad­dicts the best treat­ment pos­si­ble.

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