In the summer 2013 issue of AT Forum, one theme keeps coming up—and driving—the story for opioid treatment programs (OTPs). It is health care reform—the Affordable Care Act (ACA), which goes into full-implementation mode in January 2014. Patients are going to be signing up for Medicaid and commercial insurance, which will reimburse OTPs for services as early as October, when the exchanges open up. That’s right around the corner, and it’s a major change in the reimbursement landscape.
This issue’s interview with Elinore F. McCance–Katz, MD, the new medical director of the Substance Abuse and Mental Health Services Administration (SAMHSA), is a case in point. The federal government’s regulator of OTPs is talking about health homes. It’s a big challenge, but something that OTPs, with their comprehensive services, are ready for.
That takes us to the story on the SAMHSA draft guidelines for OTPs, which give unprecedented authority to physician assistants and nurse practitioners, making it much easier for programs to accommodate increased patient loads. In another set of guidelines, the City of Philadelphia—which is hosting the American Association for the Treatment of Opioid Dependence annual meeting this fall, where the SAMHSA guidelines are expected to be released—has funded a landmark recommendation for managing benzodiazepine use in OTPs. That story is detailed in a fascinating interview with Roland Lamb.
And on a state level, California is in the midst of a good-news, bad-news scenario—with the good news overwhelmingly outweighing the bad. California’s Medicaid program is expanding under the ACA, allowing many patients who were previously uncovered by insurance to have coverage. That means that instead of struggling to come up with the funds to pay for treatment in OTPs, these patients will be paid for by Medicaid. The bad news comes for patients on the exchanges, where people buy their own commercial insurance with subsidies: methadone maintenance in OTPs is not covered, but buprenorphine maintenance from a physician, with no required counseling, is. At the same time, OTPs in California, as elsewhere, continue to make the case for comprehensive services.