Methadone Treatment Expansion in Baltimore Reduces Waiting Lists

Baltimore, once called by the Drug Enforcement Administration the “heroin capital of the U.S.,” no longer deserves that epithet, says Yngvild Olsen, MD, MPH, medical director and vice president of clinical affairs at Baltimore Substance Abuse Systems, Inc. (BSAS). More heroin users are getting into treatment, including methadone maintenance, thanks to Maryland’s newly expanded Primary Adult Care (PAC) health coverage program. Maryland Medicaid is now paying, for the first time, for comprehensive medication-assisted treatment (MAT) for everyone who qualifies financially, opening up publicly funded methadone treatment to single men without dependent children.

The revised PAC program took effect in January 2010. It was an expansion of the original PAC program, which allowed uninsured people not eligible for traditional Medicaid—mostly childless low-income men—access to outpatient mental health services, prescriptions, and primary care. The one thing the program did not cover was addiction treatment.

Increased Medicaid Reimbursement Rate for Methadone Treatment

In 2009, the Maryland state legislature voted to take $6.7 million from state substance abuse treatment funds and moved it to Medicaid. In return, Medicaid increased the reimbursement rates for methadone maintenance (MM) treatment, as well as for intensive outpatient and outpatient addiction treatment. Medicaid also made these services part of the PAC benefit package.

“They got rid of the preauthorizations and a lot of other things managed care organizations put up to limit access,” says Dr. Olsen. “Methadone programs now just have to submit notifications of treatment with a clear clinical rationale for why a patient needs this treatment. Every 26 weeks, the program then repeats the process for that patient.”

As a result of these changes to the PAC program, opioid treatment programs (OTPs) have been able to admit new patients and access the higher rates. Some programs expanded their actual physical space, while others maximized patient capacity within their current space. They hired more counselors and expanded their hours. In addition, new private programs opened in Baltimore, or added new sites.

Waiting Lists

The expansion has virtually eliminated waiting lists in the programs that are reimbursed by the higher Medicaid rates under PAC, says Dr. Olsen. There are 12 OTPs in Baltimore that currently receive grant funds in addition to PAC reimbursement. As of October 3, 11 responded to a BSAS query about OTP waiting lists.

Of the 11 programs that responded, three hospital-based programs still have waiting lists as they cannot access the rate structure of the PAC program and are primarily dependent on grant funds.  Because of this, these three programs with waiting lists are representative of how the entire OTP system looked prior to PAC, says Dr. Olsen.

Of the remaining eight community-based programs, three have waiting lists of one to four weeks for uninsured individuals, but no waiting list for those with PAC or another form of insurance.

The other five programs have no waiting lists either for uninsured or insured patients, and are continuing to increase their capacity, by expanding the location and by extending service hours, she says. “These programs also told us that they can expand because uninsured patients often get PAC within 60 days of treatment admission.”

The survey does not include the private programs in Baltimore that do not receive grant funds but do accept PAC, but Dr. Olsen says she doesn’t think there is a waiting list at these clinics for insured patients based on information circulating in the community.

Peter M. Cohen, state opioid treatment authority for Maryland, confirmed that there are no long waiting lists for methadone in Baltimore. And here’s the proof. Baltimore had four interim methadone maintenance programs designed to get people in MM treatment right away. As of July 1, “we determined the need isn’t there for those interim programs.”

There are currently 2,231 methadone slots for the uninsured in Baltimore, and about 500 to 600 patients are maintained on buprenorphine

Baltimore, once called by the Drug Enforcement Administration the “heroin capital of the U.S.,” no longer deserves that epithet, says Yngvild Olsen, MD, MPH, medical director and vice president of clinical affairs at Baltimore Substance Abuse Systems, Inc. (BSAS). More heroin users are getting into treatment, including methadone maintenance, thanks to Maryland’s newly expanded Primary Adult Care (PAC) health coverage program. Maryland Medicaid is now paying, for the first time, for comprehensive medication-assisted treatment (MAT) for everyone who qualifies financially, opening up publicly funded methadone treatment to single men without dependent children.

The revised PAC program took effect in January 2010. It was an expansion of the original PAC program, which allowed uninsured people not eligible for traditional Medicaid—mostly childless low-income men—access to outpatient mental health services, prescriptions, and primary care. The one thing the program did not cover was addiction treatment.

Increased Medicaid Reimbursement Rate for Methadone Treatment

In 2009, the Maryland state legislature voted to take $6.7 million from state substance abuse treatment funds and moved it to Medicaid. In return, Medicaid increased the reimbursement rates for methadone maintenance (MM) treatment, as well as for intensive outpatient and outpatient addiction treatment. Medicaid also made these services part of the PAC benefit package.

“They got rid of the preauthorizations and a lot of other things managed care organizations put up to limit access,” says Dr. Olsen. “Methadone programs now just have to submit notifications of treatment with a clear clinical rationale for why a patient needs this treatment. Every 26 weeks, the program then repeats the process for that patient.”

As a result of these changes to the PAC program, opioid treatment programs (OTPs) have been able to admit new patients and access the higher rates. Some programs expanded their actual physical space, while others maximized patient capacity within their current space. They hired more counselors and expanded their hours. In addition, new private programs opened in Baltimore, or added new sites.

Waiting Lists

The expansion has virtually eliminated waiting lists in the programs that are reimbursed by the higher Medicaid rates under PAC, says Dr. Olsen. There are 12 OTPs in Baltimore that currently receive grant funds in addition to PAC reimbursement. As of October 3, 11 responded to a BSAS query about OTP waiting lists.

Of the 11 programs that responded, three hospital-based programs still have waiting lists as they cannot access the rate structure of the PAC program and are primarily dependent on grant funds. Because of this, these three programs with waiting lists are representative of how the entire OTP system looked prior to PAC, says Dr. Olsen.

Of the remaining eight community-based programs, three have waiting lists of one to four weeks for uninsured individuals, but no waiting list for those with PAC or another form of insurance.

The other five programs have no waiting lists either for uninsured or insured patients, and are continuing to increase their capacity, by expanding the location and by extending service hours, she says. “These programs also told us that they can expand because uninsured patients often get PAC within 60 days of treatment admission.”

The survey does not include the private programs in Baltimore that do not receive grant funds but do accept PAC, but Dr. Olsen says she doesn’t think there is a waiting list at these clinics for insured patients based on information circulating in the community.

Peter M. Cohen, state opioid treatment authority for Maryland, confirmed that there are no long waiting lists for methadone in Baltimore. And here’s the proof. Baltimore had four interim methadone maintenance programs designed to get people in MM treatment right away. As of July 1, “we determined the need isn’t there for those interim programs.”

There are currently 2,231 methadone slots for the uninsured in Baltimore, and about 500 to 600 patients are maintained on buprenorphine.

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