A state proposal to significantly change how it pays clinics and health facilities that administer methadone treatment to recovering drug addicts has some drug treatment centers worried it would put them out of business.
State mental health officials say the proposed changes to Medicaid reimbursement rates for methadone treatment would offer drug treatment programs more incentive to provide better counseling services to addicts.
The proposal by the Behavioral Health Administration, which oversees the public mental health and substance abuse system, calls for reducing Medicaid payments for methadone treatment from $80 per week to $42 per week, while potentially increasing what programs can get for counseling services.
But drug treatment centers say the cut in methadone reimbursement rates would severely reduce the revenue needed to keep their doors open and leave small clinics particularly vulnerable.
"This could be extremely destructive," said Barbara Wahl, business operations director at Concerted Care Group, which operates a methadone clinic in Baltimore and recently announced it was expanding to other parts of the state. "This is the last thing our patients need right now."
Methadone is an opiod medication that is often used to wean drug addicts off heroin and other narcotics without causing the high, or the painful withdrawal symptoms, associated with those other drugs.
Officials with the Department of Health and Mental Hygiene, which oversees the Behavioral Health Administration, say the changes are merely structural and will keep clinics financially sound.
The current reimbursement model lumps all methadone treatment, including drug disbursement and counseling, into one category. A clinic is reimbursed one weekly fee for a patient no matter how many counseling sessions they attended, methadone treatments they receive or other services they tap.
The proposal would separate counseling services, allowing for higher reimbursement payments. Counseling is reimbursed at various rates depending on the intensity of the treatment. Outpatient group counseling sessions are paid at a rate of $29 per session, while intensive treatment is $125 per session.
"I think a different picture emerges when you consider all the different types of counseling a provider can ensure a patient receives," said Christopher Garrett, a health department spokesman. "Equipping the patient through counseling doesn't necessarily mean a provider will lose money, even a small provider. The goal is for the patient to get better and to graduate from the need to receive services from the provider."
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 proposed 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 arose time and again at hearings held by the task force across the state this year, said Doug Mayer, a Hogan spokesman.
"This is a problem that looks to ensure that people are getting the correct level of counseling," Mayer said. "This doesn't affect anyone's bottom line if they are providing counseling. The overall effort is to ensure that it's not just methadone, that it is counseling as well, which is an important part of treatment."
Drug treatment centers and other providers were part of the discussion when drafting the new reimbursement proposals, state health officials said.
"Providers are among the stakeholders involved in the development of this proposal," Garrett said. "It is not something the state conceived of in a vacuum without input from the community or the provider industry."
Drug treatment centers received letters about the proposed changes this week.
Their operators 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 be counterproductive, they said.
"What this proposal will do is bankrupt every methadone clinic in the state," said the Rev. Milton Williams, president of Turning Point Clinic, which serves 2,100 addicts a day from its East Baltimore clinic. "It is an effort to shut down methadone clinics in Maryland."
Concerted Care Group's Wahl said the proposal also would provide less flexibility for patient care. Intensive outpatient treatment sessions tend to be more restrictive, she said. Patients who work may prefer to come to shorter sessions in the evenings.
"I think the spirit of the proposal is in the right place," Wahl said. "It encourages more counseling, which is what we want to provide. It is just the way they want us to provide it that may be more burdensome then what they intended it to be."
The recommendations are far from a done deal. The department will take public comments on the matter through next month.
"This is a proposal that is up for public hearing and we will hear what the public has to say about it," Mayer said.
About 90 people attended an emergency meeting of the Maryland chapter of the American Association for the Treatment of Opioid Dependence to discuss the implications of the reimbursement changes with staff from the state's Medicaid and behavioral health office.
The group said it needs more time and information to determine how the proposals would effect treatment centers as the drug addiction problem grows.
"They are certainly looking for suggestions from providers," said Marian Currens, the group's president and associate medical director at the Center for Addiction Medicine in Baltimore. "There are certainly some centers that think they will have to close, but they said this is a proposal. This is not a done deal.
Yngvild Olsen, the association's immediate past president, said she was glad to hear state officials emphasize they are not trying to cut treatment given the state's opioid epidemic.
"They are not about decreasing access to treatment," she said. "Given the heroine epidemic they are very much about keeping treatment as broad as possible."
Still, some clinics are planning to protests against the proposal.
Baltimore Health Commissioner Dr. Leana Wen said her office will pay close attention to the changes so that it does not disrupt or hurt treatment for addicts. She said the intent of the changes are to give treatment centers more flexibility, but it is unclear how it will impact individual treatment centers.
"We are working with them so we can convey their best interests and their concerns with the Hogan Administration," Wen said. "Ideally we want it to have the least negative impact."