Expansion of residential drug treatment reimbursement under way
Guidance to providers is first step toward helping more people get inpatient help
Baltimore, MD (May 12, 2017) – Maryland expansion of residential drug treatment reimbursement advanced today, as the Medicaid program sent guidance materials to providers in advance of the July 1 implementation. The expansion, solidified in the program’s federally approved waiver, will enable providers to receive previously denied reimbursement, a statutory obstacle that contributed to the opioid crisis here.
“The expansion of this reimbursement to residential treatment providers could not come at a better time,” said Health and Mental Hygiene Secretary Dennis R. Schrader. “We are so grateful for the support Gov. Larry Hogan provided for our Medicaid waiver application that featured this reimbursement as a linchpin of the policies put in place to combat the opioid epidemic.”
Medicaid’s expansion of treatment reimbursement and similar policies coincide with Governor Hogan declaring a state of emergency in Maryland and forming the Opioid Operational Command Center, which works to improve state and local agencies’ collaborations to raise awareness and to save lives.
The IMD Waiver, approved by the U.S. Centers for Medicare & Medicaid Services on December 27, 2016, will provide Medicaid reimbursement for inpatient, 8-507 treatment services. This will increase provider capacity and Marylanders’ access to these services. The federal IMD exclusion has prohibited Medicaid reimbursement for adults between the ages of 21 and 64 who are receiving services provided in a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care and treatment of individuals with mental diseases.
Because of this non-payment policy, many Medicaid enrollees with acute psychiatric and addiction treatment needs have been referred to hospital emergency departments and general acute care inpatient units, rather than smaller, community-based specialized providers with expertise to care for these individuals. The IMD exclusion waiver is part of a series of innovations being employed by the Medicaid program to combat the opioid epidemic.
In partnership with all eight of its HealthChoice managed care organizations, the program Maryland Medicaid is working to reduce opioid misuse, dependence, overdose and death in both Medicaid fee-for-service and HealthChoice managed care programs.
HealthChoice policy changes, effective July 1, 2017, will work to:
· Prevent medical and non-medical opioid use, abuse, and substance use disorder from developing;
· Identify and treat opioid dependence early in the course of the disease;
· Prevent overdose deaths, medical complications, psychosocial deterioration, transition to injection drug use, and injection-related disease; and
· Identify and outreach to providers who do not follow standard practice.
All high-dose and long-acting opioids, including fentanyl prescriptions issued to Maryland Medicaid members, are now subject to prior authorization. In addition to these new prior authorization requirements, Maryland Medicaid is also encouraging providers to:
· Consider non-opioids as first-line treatment for chronic pain;
· Offer naloxone to patients who meet certain risk factors;
· Conduct thorough substance use disorder screening prior to prescribing opioids;
· Refer patients to treatment that are identified as having a substance use disorder; and
· Use the Department’s Prescription Drug Monitoring Program for all Controlled Dangerous Substance prescriptions.
This joins the May 15, 2017, implementation of a payment policy for community-based Medication Assisted Treatment (MAT) – a clinical intervention that combines the use of medications and substance use disorder counseling. Medicaid will now provide a re-bundled methadone reimbursement rate to include a $63 per-week-per-patient bundle for methadone maintenance, and the ability for Opioid Treatment Programs (OTP) to bill for outpatient counseling separately, as clinically necessary.
This July, the HealthChoice program will mark its 20th year. Since 1997, HealthChoice has helped Maryland Medicaid manage cost, enhance service utilization, and increase health care quality for Medicaid recipients. Today, HealthChoice serves more than 80 percent of Marylanders enrolled in Medicaid. Eight managed care organizations partner with the Department to ensure access to quality services through a broad network of providers across the state.
Last year, Maryland Medicaid marked its 50th year of serving Maryland’s most vulnerable populations through the provision of medically necessary services.