Time short for federally funded opioid program

An experimental mental-health and addiction treatment program that has shown early success at combating the opioid crisis is at risk of losing its federal funding.

Some 9,000 patients could lose access to medication-assisted treatment, and 3,000 clinic jobs could be lost if funding is not renewed, according to the National Council for Behavioral Health. Some states may feel the impact as early as January, since clinics must give staff 60 to 90 days’ termination notice.

Lawmakers in both parties have committed to boosting mental-health and addiction treatment to address the opioid epidemic, but new funding for the behavioral-health clinics initiative was not included in the $8.4 billion package Congress passed in October.

“There was a lot of concern in Congress about the overall cost of the package,” said Rebecca Farley David, vice president for policy and advocacy at the National Council for Behavioral Health. Advocates cited an estimate of $520 million to continue the initiative, a cost that bill sponsors and the Congressional Budget Office could not confirm.

David called the program’s exclusion from the package “a missed opportunity,” pointing out that it is already tested, established and implemented.

Matt Salo, executive director of the National Association of Medicaid Directors, said Medicaid’s move toward “value-based payments,” which reward providers with incentive payments according to the quality of care delivered, does not align with the clinics’ system, in which Medicaid reimburses providers fixed amounts for bundled services.

“It sets payment rates at a higher level than what we would pay anybody else for doing the same thing,” he said.

Clinic directors and advocates pointed out that many therapies, including psychiatry, are often reimbursed at rates far below the actual cost to deliver services, and the bundled payments close some of that gap.

The experimental program was set up after legislation in 2014 established standards for a new clinic designation called Certified Community Behavioral Health Clinics and created flexible funding that allowed the clinics to expand patient outreach and services for two years. The program kicked off in eight states in 2017, and during its first, it year served an estimated 381,000 patients, according to a report from the Substance Abuse and Mental Health Services Administration.

Clinics in Oklahoma and Oregon would be the first to lose funding, as their programs expire at the end of March. In Minnesota, Missouri, Nevada, New York, New Jersey and Pennsylvania, the demonstration program runs through the end of May.

Given the looming deadline, states are frantically devising alternative plans. Some are applying for Medicaid waivers, which require periodic renewal and are a larger administrative burden. Others are seeking one-time grants to keep the staff they’ve hired.

Sen. Debbie Stabenow, D-Mich., co-sponsored both the 2014 legislation and the extension bill now in committee. She cited the need for parity between treatment for mental health and physical health as an inspiration for the initiative. The clinics are required to provide access to nine services, including emergency crisis intervention, medication-assisted treatment and psychiatric rehabilitation.

CHRIS CARLSON / ASSOCIATED PRESS 2017 Inmates attend a program in 2017 at Twin Towers Correctional Facility in Los Angeles. It houses perhaps the world’s largest group of inmates whose mental illness is attributed to drug abuse.