Pubdate: Mon, 18 Jan 2016
Source: Baltimore Sun (MD)
Copyright: 2016 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37

HELPING ADDICTS RECOVER

Our View: Change in Methadone Reimbursement Must Be Carefully Managed

As the number of heroin overdose deaths in Maryland continues to 
rise, advocates for some drug treatment clinics are expressing alarm 
over a state proposal to change how such facilities are funded.

The changes are intended to encourage clinics that serve recovering 
addicts to provide more counseling and other services to people 
trying to kick the habit.

But the treatment centers fear the new rules could put them out of 
business if they result in substantial cuts in the reimbursement 
clinics receive for administering the drug methadone, which is used 
to wean addicts off heroin and other narcotics. The state needs to 
adopt a balanced approach that keeps as many drug treatment 
facilities open as possible but also offers clinics and health 
facilities more incentives to offer a broader range of services.

The state Behavioral Health Administration, which oversees the public 
mental health and substance abuse system, has called for reducing 
Medicaid payments for methadone treatments from $80 per week to $42 
per week. To compensate for that loss of revenue, the agency is 
proposing substantial increases in the amount programs can charge 
Medicaid for drug counseling and other services, which in some cases 
could amount to up to $125 per session.

The new rules are designed to encourage evidence-based standards of 
care that provide a combination of both methadone maintenance and 
intensive counseling, therapy and social support programs.

Currently, the state does not reimburse clinics and health facilities 
for counseling services.

Instead, it lumps charges for methadone maintenance, counseling and 
any other services clinics offer into one weekly fee regardless of 
how many counseling sessions a client attends, methadone treatments 
they get or other services they receive. Since many clinics across 
the state don't have the resources to quickly ramp up additional 
services, the $80 weekly fee they receive for administering methadone 
provides the bulk of the funding needed to pay their staffs and 
maintain their facilities. For providers operating on a shoestring 
budget, any change in the formula that cuts the reimbursement for 
methadone maintenance in half looks like a disaster.

At the same time, however, one needs to consider the situation of 
clinics that already are providing significant counseling and other 
services for recovering addicts - yet are not getting reimbursed for 
those services under the current formula.

Moreover, the expanded services these clinics offer are by no means 
dispensable add-ons or "frills." They are in fact a crucial element 
of the basic standard of care that professional groups like the 
American Medical Association and the World Health Organization have 
all endorsed as needed for successful drug treatment and recovery.

By separating Medicaid reimbursement for methadone maintenance from 
counseling and other therapies, state officials hope to nudge all 
Maryland drug treatment clinics toward offering a comprehensive 
package of services for long-term recovery.

One of the oft-heard misconceptions about methadone is that patients 
can remain on the drug for years or even decades without ever kicking 
the habit.

Some critics have charged that methadone is even more habit-forming 
than heroin or cocaine and that maintenance programs based on the 
drug actually do addicts a disservice because they merely trade one 
addiction for another.

What such criticisms fail to recognize is that addiction, like 
hypertension or diabetes, is a chronic disorder that can be 
effectively managed through a combination of medication and 
counseling even though in many cases it can never be completely 
"cured." The fact that somebody stays on medication a lifetime 
doesn't make the therapy ineffective.

That's why the state's strategy of offering incentives for drug 
clinics and health facilities that provide additional counseling 
services is fundamentally sound in theory, though it will require 
Maryland to be flexible in cases where providers require more time to 
get new programs up and running.

Baltimore City Health Commissioner Dr. Leana Wen recently wrote to 
state Department of Health and Mental Hygiene Secretary Van T. 
Mitchell expressing support for the proposed changes so long as the 
transition is carefully managed.

Maryland can never substantially reduce drug overdose deaths if it 
doesn't reduce such fatalities in the city, and no one wants to see 
clinics forced to interrupt service or close at a time when they are 
needed more than ever.
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MAP posted-by: Jay Bergstrom