More on Reimbursement

Change proposed in Medicaid payments to Maryland methadone clinics

The state of Maryland is proposing significant changes to how its Medicaid system doles out cash to methadone treatment clinics. 

And some operators of such facilities aren't happy about it.

Currently, the state's Department of Health and Mental Hygiene stipulates that Medicaid pay methadone clinics $80 per patient per week, in a bundled payment meant to cover both the administering of methadone and counseling services for recovering addicts. Methadone is a compound that quells an addict's withdrawal symptoms without delivering a euphoric high.

The suggested change, which DHMH Communications Director Christopher Garrett said is "still very much in the proposal phase," would result in Medicaid paying $42 per patient, per week for their methadone treatment, with reimbursement for counseling services left more open-ended.

The proposal "would then leave a provider open to be reimbursed at various rates for the counseling portion of their programs," said Garrett.

To illustrate how the change would work, Garrett offered a hypothetical situation: Say Joe, a recovering addict, is seeking treatment at Clinic X. Currently, his $80 monthly "allowance" would be used to cover his counseling and his doses of the methadone compound, helping to quash his addictive urges -- and not a dime over that $80 limit can be spent.

If the proposal gains traction, then Joe would only be able to use $42 worth of methadone in a given week, but would have access to as much counseling as he and the clinic feel is necessary, over and above the current $80 limit, if need be, with the difference to be paid by Medicaid.

"There's the potential … to bill Medicaid for a higher price," said Garrett, adding that the goal of the proposal is to "make sure the facility has the well-being of the patient in mind."

Barbara Wahl isn't so sure that's how it would play out.

Wahl, the business operations director at Concerted Care Group in Baltimore, said counseling sessions are not mandatory -- and shouldn't be, as it would "restrict patient freedom." Family and life commitments can get in the way, she said, meaning many patients won't be able to take advantage of the potential for higher counseling reimbursement, which would in turn affect the overall funding of drug treatment clinics.

"We're kind of worried about how it's going to change the whole landscape," said Wahl. "Right now, as it stands, it cuts our reimbursement rates in half. You want to offer the same services, but that would be difficult if the proposal goes through."

Among her other concerns are the potential need to hire additional staff, as well as managing patient safety, especially in crime- or drug-ridden areas.

Garrett said that even small providers shouldn't lose money on the deal, and that the changes are merely "structural." He said the proposed changes were prompted by a state task force which identified a lack of adequate counseling services.

Medicaid is the federal health insurance program administered by the state for low-income individuals. Its reimbursements are funded by both the state and federal government, and are used to pay treatment centers, hospitals and health clinicians serving these residents.

DMNH will be taking public comments on the proposal through the end of January.

Twitter: @JELagasse