Medicaid drug reimbursement to put more focus on counseling

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 also will 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.

"I think that really understanding that in order to provide and be able to actually use opioid treatment program services in a clinically flexible way, the reimbursement structure had to change so there was some allowance for more counseling services and allowance for different levels of care," said Dr. Yngvild Olsen, medical director at The Institutes for Behavior Resources, a Baltimore drug treatment center.

The reimbursement changes are a direct result of recommendations made by a state task force named by Gov. Larry Hogan and chaired by Lt. Gov. Boyd K. Rutherford. The lack of adequate counseling services was an issue that repeatedly came up at hearings across the state held by the task force.

State health officials and other critics said the old model gives drug treatment facilities little incentive to put patients in counseling.

By separating counseling services, the new method allows for higher reimbursement payments for those services. Counseling is reimbursed at various rates depending on the intensity of the treatment.


"Providers are required by federal law to provide counseling along with needed medications, and these changes are intended to move the treatment providers in the direction of more evidence-based practice," Health and Mental Hygiene Secretary Van T. Mitchell, said in a statement.

The state plans to amend the current regulations in coming months and then must seek approval from the federal government.


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