This summer, the Tennessee Health Services and Development Agency (HSDA) granted a Certificate of Need (CON) for the establishment of a new opioid treatment program (OTP) in Maryville, Blount County, Tennessee. Owned by The Patricia Hall Talbott Legacy Centers, LLC, a company named after the founder’s mother, and doing business as TLC Maryville, the Maryville OTP will provide methadone, buprenorphine, and naltrexone – the three approved medications for the treatment of opioid use disorder (OUD) along with counseling and other psychosocial support services.
The path to this CON was arduous, but Zachary C. Talbott, MSW, LADAC, CAADC, MAC, CCS, President and CEO of the company, has done this before – in Georgia and in North Carolina. The OTP will have both an OTP component and an office-based opioid treatment (OBOT) component.
“We are thrilled to be going home to establish what will become only the 6th OTP in the entirety of Eastern Tennessee,” said Mr. Talbott. “Unlike some other OTPs, TLC Maryville will offer all three FDA-approved medications for opioid use disorder, and we will offer buprenorphine in both OTP as well as office-based programs depending on the needs of the individual served.”
TLC Maryville was approved with a proposed service area of Blount, Loudon, Sevier, Monroe, and McMinn Counties. In these five counties alone, HSDA staff estimated nearly 4,000 individuals with an OUD in need of treatment. All 5 counties are designated as “high need” for opioid treatment services by the U.S. Office of the Inspector General (OIG). Open records requests from neighboring states show that nearly 200 patients of the 5 county service area are driving 1.5 to 2 hours each direction into Georgia for OTP services and 15 patients are driving 1.5 hours into North Carolina for OTP services.
Support for the CON came from Blount County Mayor Ed Mitchell, Blount County Circuit Court Clerk Tom Hatcher, Program Director of the Blount County Recovery Court & Veterans Treatment Court Amy Galyon, Senior Pastor of East Maryville Baptist Church Rev. Keith Johnson, Associate Pastor of Sevier Heights Baptist Church Charles McNutt, Executive Director of the Knoxville,based Metro Drug Coalition Karen Pershing, North Carolina State Opioid Treatment Authority Smith Worth, ReVIDA Recovery Chief Compliance Officer Amy Morris, and American Association for the Treatment of Opioid Dependence (AATOD) President Mark Parrino. Director of Blount Memorial Physicians Group Cory M. Everett provided written documentation of having been notified of the project while writing, “we look forward to a partnership that benefits our patients and community as a whole.” Multiple community leaders and local residents expressed support for the project through written letters, as well.
“The build out is set to begin on September 14th, and then state licensing, SAMHSA certification, and DEA registration will be obtained,” Mr. Talbott told AT Forum after the CON was granted. “The earliest opening would likely be mid-December, but we anticipate that it could be first quarter 2021 before TLC Maryville opens its doors to begin serving patients.”
The vote was 9-0 by the Tennessee HSDA to grant the CON.
A CON was granted for a new OTP (New Hope Treatment Center) in Newport in December of 2018 and a new OTP (BHG Murfreesboro Treatment Center) in Murfreesboro in December of 2019. Neither New Hope nor BHG Murfreesboro have initiated services as of the publication of this article. CONs for OTPs in Tennessee expire after two years if the project has not been completed.
From the “contractor risk agreement” from TennCare (the contractor is the managed care contractor paid by TennCare, which in turn pays the OTP):
“The contractor shall establish a provider network by July 1, 2020 for Methadone Medication Assisted Treatment (MAT) for members with opioid use disorder (OUD) as outlined by TennCare. The contractor shall comply with all guidance set forth by the TennCare Methadone Program Description. The contractor shall reimburse the Methadone Medication Assisted Treatment providers at a rate specified by TennCare through December 31, 2021. The contractor shall also use the payment methodology as specified by TennCare. The contractor shall meet with each TDMHSAS licensed Opioid Treatment Program and offer each facility a contract for Methadone Medication Assisted Treatment. If the contractor has quality of care concerns that may prevent contracting with the Opioid Treatment Program, the contractor shall inform TennCare of this finding.”
Also from the contractor risk agreement is the following definition of OUD treatment:
Treatments for opioid use disorder are designed and delivered across the continuum of care including but not limited to hospital, residential treatment, Intensive Outpatient Program, Office-Based Opioid Treatment, Opioid Treatment Program, primary care and peer recovery services. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful. The duration of treatment should be based on the needs of the persons served. For opioid use disorder, one essential component within the continuum is Medication Assisted Treatment. Medication Assisted Treatment (MAT) for persons diagnosed with opioid-use disorder is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. The medications used to achieve treatment goals include buprenorphine, naltrexone, and methadone products approved by the Food and Drug Administration (FDA) for the use in the treatment of opioid-use disorder. All providers treating members with opioid use disorder must either provide Medication Assisted Treatment (MAT) or have a policy for referral to a MAT provider for those members wishing to access MAT. Providers must also maintain compliance with the licensure rules and/or program standards set by TDMHSAS to render MAT Services.
Business booming in Tennessee
Now that Medicaid is paying for treatment in Tennessee, other OTPs are seeking patients there – and Talbott is concerned that some treatment doesn’t meet his high standards for comprehensive care. When he decided to move back to his home state of Tennessee, at the time, Tennessee still banned Medicaid – TennCare – for OTPs. This year, however, the state reversed course, and now allows Medicaid to pay for methadone treatment.
Notably, states like New York, where Medicaid has always paid for OTP treatment, have very few proprietary programs. The Medicaid bundled weekly rates for methadone are $125, which is more than most Tennessee OTPs charge self-pay patients. The additional money will make it possible to hire billing staff and implement utilization review processes, thus making the net revenue with Medicaid similar to self-pay patients.
It is the sheer volume of new patients that is expected in Tennessee which necessitates the approval of these new CONs, one of which is TLC Maryville.
As for buprenorphine and naltrexone rates, these must be negotiated in individual program contracts directly with TennCare.
Bottom line: the weekly rate, for per diem treatment for methadone, is $125 from TennCare
The unique characteristics of TLC Maryville – the co-existence of OTP and OBOT models, with methadone and buprenorphine and naltrexone all available in OTP, and buprenorphine and naltrexone in OBOT, along with comprehensive services, are a high bar for other programs to meet.
For more information, go to https://www.tn.gov/content/dam/tn/tenncare/documents/MethadoneBillingInformation.pdf