Funding for MMT
Peter Rockholz (CT) (7/10/07) asks:
How do states fund/purchase methadone maintenance? Bundled rate? Unbundled? Fee-for-service/grant? How much does Medicaid figure in? What is the private nonprofit/for-profit split out? Any other thoughts?
Dennis Malmer, WA:
WashingtonState implemented a new bundled rate of $12.31 per day July 1, 2007, for public-funded patients. We have both public funded and private, for-profit OTPs in our state.
Louise Polansky, IN:
Indianaprovides SAPT Block Grant funding to two clinics, both run by public community mental health centers, one in northern Indiana (Gary) and one in Central Indiana (Indianapolis). Together, these two clinics serve approximately 500 patients a year. The State provides approximately $2,500 per patient per year for as many patients as the two clinics can treat for that. Both of these clinics also charge their patients on a sliding fee basis in addition to the funding we provide. The daily service fee ranges from approximately $35 - $42 if patients pay the full rate, and both of these clinics also admit private-pay patients. One of these two clinics captures Medicaid funding for its patients who are eligible for Medicaid (Gary),limited to women with dependent children or who are pregnant and individuals who have a co-occurring mental illness. A third clinic in an Indiana community mental health center is awaiting CSAT approval and is not presently operating.
The other clinics (11 in total) in Indiana areall private, self-pay and receive no public funding. I don't believe that any of them receive Medicaid funding, although I'm told that patients on Medicaid may submit to Medicaid for reimbursement of some opioid addiction treatment services.
BrendaLands, LA:
All of our clinics are "for profit." The state only purchases methadone for natural disasters such as hurricanes.
Richard Moldenhauer, MN:
In Minnesota, we have a blend of public and private monies. The private pay clients are just that, private pay. The public pay are part of our Consolidated Chemical Dependency Treatment Fund (CCDTF). Counties contract with vendors, all fees inclusive for a daily rate. The average is about $14 per person per day. They usually write the Client Placement Authorizations (CPA) for 6 months at a time.
Buddy Stephens, TN:
In TN all clinics are private for profit. The TennCare waiver excludes MMT as a covered service and does not pay. Patients must pay the entire cost of the service. Average price in TN is $11-13 per day.
Wayde Glover, VA:
There are 19 MMT programs in Virginia. Six are publicly funded, including a Veterans Administration program, federally funded. The public programs are subsidized byblock grand funding as well as charge a fee for services. All programs private and public use a bundled daily rate ($10-$15 a day). MMT was added to Medicaid July 1st. The reimbursement is unbundled and at this time is not favorable to most providers. There is talk by many of our private providers to boycott the process until more favorable reimbursement rates are established.
MMT is significantly under funded and the existing programs do not meet the needin our state. Regulations regarding siting programs have made it difficult for expansion and most programs have waiting lists. Public and legislative stigma has made it difficult to address the need.
Stacy Mullins, AR:
In Arkansas we have one publicly funded (fee for service) and one private for profit MMT. Medicaid does not pay for any substance abuse treatment in the State of Arkansas.
Rosemary Shannon, NH:
NH's eight community based clinics are all private for-profit, fee-for-service entities, and do not receive any Block Grant or state general funds through the Alcohol and Other Drug Abuse Treatment Section (AODATS). However, all programs are regulated by our unit (State Methadone Authority designee, I am),
AND,
about 3-4 years ago our Medicaid program decided that MMT was a MEDICAL SERVICE (as a result of a pregnant woman being in danger of losing coverage when the state dropped its managed care contract with a national provider who had MMT services in it's treatment mix).
As a result, without any input from AODATS, Medicaid decided that the mix of pharmacy, physician and nursing services (not LADC counseling, as it is not in the state Medicaid plan) was worth $105 per week. We did eventually consider it a "bundled rate" about a year ago, to prevent one of the providers from charging Medicaid clients an extra $20 per week for "LADC counseling."
Merritt Moore, WV:
West Virginia has only for profit clinics. Medicaid does not pay for methadone. We are working with the Bureau for Medical Services to have
buprenorphine reimbursed by Medicaid for approved programs. This is to ensure that comprehensive services are provided and not just medication only.
Michele Flowers, KY:
In KY we have a total of 9 clinics, with 7 of those being private, for profit and receiving no funding from us. We have 1 program in Lexington that is run by the CMHC and receives funding for about 120 clients. There is another public program in Louisville that is run by the health department and they receive funding for an estimated 200 clients. Each of these 2 programs receives a set amountfrom us annually that ends up averaging about $2500 per client. Since this does not cover the full costs, clients pay a small fee based on a sliding scale if they can afford to.
Medicaid does not cover Methadone treatment and only covers SA tx in general for pregnant women. All of our clinics have bundled fees and the average for all the privates is about $90/wk. We have one private clinic whose clients are mostly upper middle class and many have insurance. They have had luck with unbundling services and billing the costs of clinical services to the insurance and then just charging the client for the medication.
Deb Powers, WI:
Wisconsin's programs are all for-profit and we do not purchase any "slots." All our block grant funds get funneled to our 72 counties and they determine if they will purchase MMT services from a program in their county. The only exception is MilwaukeeCounty (which is our largest county and has the most methadone programs) - they receive ATR funds in addition to the block grant funds and vouchers are provided for clients who meet the eligibility criteria and wish to enroll in MMT services.
In the not so distant past, MilwaukeeCounty has "bundled" and "unbundled" the services and there was not much of a noticeable difference.
I had worked with our Medicaid (medical assistance) section to develop codes for MMT services - there were no specific codes prior to 2002.
I'm providing the link if you are interested in how we have the codes identified.
Richard Weisskopf:
Illinois currently contracts for methadone services utilizing a two-tiered case rate based on the size of the program. Programs under
105 clients receive $85.35/client/week and programs 105 and over receive $68.28/client/week.
In Illinois, Medicaid reimburses for counseling services only, up to a predetermined Medicaid award in the program's contract. This differs from program to program. There was a 25 hour/client/year maximum but that has been eliminated.
I would be very interested in determining what the other states are currently reimbursing.
Paul MacFarland, ME:
Maine has one nonprofit hospital and six for profit clinics. We do cover treatment at the clinics with MaineCare (Medicaid). The Office of Substance Abuse also provides small grants to the clinics for bridge funding when an individual temporarily loses coverage, but not for continued individual funding of a treatment slot.
Kim Lucas, DE:
Delaware funds two non-profit clinics for a specific number of “slots” at each agency for uninsured clients. Medicaid does pay for counseling, but doesn’t pay for the cost of the medication. The clients are required to pay for the medication. There is also one for-profit clinic that serves self-pay clients.
Dean Austin, IA:
The state of Iowa pays for the cost of the methadone out of SAPT block grant funds to three providers. Counseling and rehabilitation services are paid through contract with the three providers through subcontract they have with our managed care organization. Medicaid also will pay for counseling and rehab through the subcontract.
Stacy Chamberlain, KS:
Kansas has 5 clinics. All are for profit agencies. We do provide public funding for one clinic using State general funds. The funding is capitated and so serves a limited number of clients. In addition 2 clinics recently became Medicaid providers and can bill for counseling services. They are required to submit a plan and agree to not bill the client for the actual medication while they receive funding for the counseling services. Kansas does not have methadone listed in the Medicaid codes.
Hilary Jacobs, MA:
Massachusetts released Draft Regulations yesterday proposing a $300 fee for all licensed substance abuse treatment programs, and an additional $75 fee for each satellite or OTP “medication unit” that is licensed under a program’s main license. Previous fees ranged from none to $25 for outpatient programs. Some MA OTP’s have dosing vans and these are considered “medication units”.
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