Push is on to lift Med­i­caid re­stric­tions on sub­stance abuse cen­ters

Modern Healthcare - - NEWS - By Vir­gil Dick­son

As the opi­oid epi­demic con­tin­ues to dec­i­mate lives across the coun­try, mo­men­tum is build­ing for mak­ing sub­stance abuse cen­ters el­i­gi­ble for Med­i­caid pay­ments.

Ear­lier this month, a bi­par­ti­san group of senators in­tro­duced leg­is­la­tion that eases fed­eral re­stric­tions on Med­i­caid re­im­burse­ment for sub­stance abuse treat­ment cen­ters. The bill would al­low cen­ters with up to 40 beds to re­ceive Med­i­caid dol­lars for stays of up to 60 con­sec­u­tive days. The leg­is­la­tion comes af­ter Cal­i­for­nia, Mary­land, Mas­sachusetts and Vir­ginia suc­cess­fully lob­bied the CMS to lift the re­stric­tions for their Med­i­caid pro­grams.

Since its in­cep­tion in 1965, Med­i­caid has re­fused to pay for care by so-called in­sti­tu­tions of men­tal dis­ease. Most res­i­den­tial treat­ment fa­cil­i­ties for men­tal health and sub­stance use dis­or­ders that have more than 16 beds did not qual­ify for Med­i­caid re­im­burse­ment.

“It’s no ex­ag­ger­a­tion to say that an avail­able bed at a treat­ment fa­cil­ity could mean the dif­fer­ence be­tween life and death. In fact, one of the most tragic cir­cum­stances is when some­one is ready to seek help, and they’re turned away be­cause of a lack of re­sources,” Sen. An­gus King (I-Maine) said in a state­ment.

King is a co-spon­sor of the bill known as the Med­i­caid Cov­er­age for Ad­dic­tion Re­cov­ery Ex­pan­sion Act, or Med­i­caid CARE Act. It’s un­clear if the law will ever be en­acted, de­spite its bi­par­ti­san sup­port, as Re­pub­li­can law­mak­ers and Pres­i­dent Don­ald Trump are ac­tively seek­ing ways to re­duce Med­i­caid spend­ing.

The Amer­i­can Health Care Act, which passed the House in early May, calls for more than $800 bil­lion in cuts to the Med­i­caid pro­gram over a 10-year pe­riod.

“AHCA cre­ates a lot of un­cer­tainty for states and could se­ri­ously ham­per progress in us­ing Med­i­caid to im­prove ac­cess to opi­oid use dis­or­der treat­ment,” said Bren­dan Saloner, an ad­dic­tion re­searcher and as­sis­tant pro­fes­sor at the Johns Hop­kins Bloomberg School of Pub­lic Health. With cuts of that size, it’s un­likely that states could con­tinue to af­ford to have their ben­e­fi­cia­ries treated in these fa­cil­i­ties, ac­cord­ing to MaryBeth Musumeci, an as­so­ciate di­rec­tor at the Kaiser Fam­ily Foun­da­tion’s pro­gram on Med­i­caid and the unin­sured. An av­er­age in­pa­tient weekly stay can range from $4,000 to $6,000 or even more.

“States are un­likely to come up with the money lost with the pas­sage of that leg­is­la­tion,” Musumeci said.

Still, a fed­eral so­lu­tion could elim­i­nate in­ef­fi­cien­cies and dif­fer­ences in state re­quests and cre­ate a sin­gle stan­dard for be­hav­ioral and sub­stance abuse treat­ment re­im­burse­ment, ac­cord­ing to Dr. Jonathan Chen, an in­struc­tor at the Stan­ford Univer­sity School of Medicine who has re­searched opi­oid abuse.

“Likely, in­ef­fi­cien­cies will arise from re­dun­dant or con­flict­ing ef­forts, and po­ten­tially in­equity when dif­fer­ent states come up with dif­fer­ent ap­proaches that are not equally ef­fec­tive,” Chen said.

Last year, the CMS fi­nal­ized a pol­icy al­low­ing Med­i­caid man­aged-care plans to pay the fa­cil­i­ties for short-term stays last­ing 15 or fewer days in a month. States such as Ari­zona and Wis­con­sin now have, or are plan­ning to sub­mit, waivers to re­move the day limit and ex­pand the new pol­icy to their fee-for ser­vice pop­u­la­tions.

The CMS has es­ti­mated that 13.8% of adults ages 21 to 64 on Med­i­caid ex­pe­ri­ence se­ri­ous sub­stance abuse dis­or­ders. The Kaiser Fam­ily Foun­da­tion has found that 3 in 10 peo­ple who are ad­dicted to opi­oids are in the Med­i­caid pro­gram.

Na­tional num­bers also show that Med­i­caid mem­bers are pre­scribed opi­oids at twice the rate of non-Med­i­caid mem­bers and have three to six times the risk of pre­scrip­tion opi­oid over­dose.

“The in­creased ef­fort at the state and con­gres­sional level is es­sen­tial to ad­dress opi­oid ad­dic­tion among the Med­i­caid pop­u­la­tion,” said Dr. Katherine Neuhausen, chief med­i­cal of­fi­cer for Vir­ginia’s Med­i­caid agency.


The bill would al­low cen­ters with up to 40 beds to re­ceive Med­i­caid dol­lars for stays of up to 60 con­sec­u­tive days.

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