The LePage administration has approved major increases in reimbursement rates for health professionals to provide medication-assisted treatment to the thousands of Mainers caught up in the epidemic of opioid use disorder.
The changes made last week come in the waning days of the eight-year term of Republican Gov. Paul LePage, and years after the opioid crisis began claiming hundreds of lives per year. Maine had 418 drug overdose deaths in 2017 and 180 deaths through the first six months of 2018.
“Considering the nature of this epidemic, it took woefully long to do this,” said Eric Haram, a Maine-based consultant who helps health systems implement opioid treatment programs. “This administration has not been expedient in addressing this problem.”
The rate increases would pay for therapy, medication and other services for those with opioid use disorder, including Suboxone, which helps curb cravings for opioids. For some services, reimbursement rates have quadrupled.
The higher payments, combined with Medicaid expansion and a significant increase in the number of doctors and other health professionals trained to prescribe Suboxone, should greatly improve access to treatment, health experts say. According to some estimates, 10,000 to 25,000 Mainers with a substance use disorder will have better access to treatment when Medicaid is expanded after Democratic Governor-elect Janet Mills replaces LePage in January.
Meanwhile, the reimbursement rate is being boosted in the Opioid Health Homes program, which was launched in 2017 by Mary Mayhew, the former Maine health and human services commissioner who is now a federal health official in the Trump administration.
The Opioid Health Homes program, which aims to provide comprehensive treatment to those with opioid use disorder, was slow to get off the ground, with fewer than 60 patients in the program in February, nearly a year after it started. In October, there were 781 patients in the program, according to state officials, before the reimbursement rates increased last week.
But with the reimbursement rate increasing from $496 per patient per month to tiered rates of $663 to $2,200 per patient per month, depending on the level of service provided, treatment providers will have a financial incentive to take on more patients. The new rates represent a fair reimbursement for services provided, treatment experts said.
BELATED CHANGES
Malory Shaughnessy, executive director of the nonprofit Alliance for Addiction and Mental Health Services, is pleased to see the increase and other improvements in the Opioid Health Homes program. But she noted that critics pointed out the flaws in the Opioid Health Homes model in 2017, and state officials were slow to react.
“We told them these same things nearly two years ago,” Shaughnessy said. “It’s unfortunate that we’ve had 600 to 700 deaths since then, and devastating for the families.”
Shaughnessy said despite how long it’s taken to act, the changes are a “very good thing.” The Opioid Health Homes also will do a better job of helping patients who have substance use disorder and a co-occurring mental illness receive mental health treatment, Shaughnessy said, calling it a crucial improvement.
Emily Spencer, spokeswoman for the Maine Department of Health and Human Services, said in an email response to questions that the administration has been improving the Opioid Health Homes program.
“We have been working with providers and the Legislature to build upon the current OHH model and believe that the program will continue to expand rapidly as more organizations sign on,” Spencer said.
Haram, the treatment consultant, said without Medicaid expansion, the state likely would have run out of funding for patients, despite the increased reimbursement rates. The Legislature approved $6.7 million for treatment, but Medicaid expansion has the potential to draw down hundreds of millions in federal dollars to pay for 90 percent of the treatment cost for each patient in the expansion population.
About 70,000 low-income Mainers will be eligible to receive Medicaid under expansion, a key component of the Affordable Care Act that has been approved in 37 states. LePage has steadfastly opposed Medicaid expansion, but voters approved a referendum in 2017 to expand the program. LePage has continued to fight implementation of the expansion in court this year, but Mills has said she would expand Medicaid “on day one” when she assumes office in January.
“Medicaid expansion is the more seismic change,” Haram said, referring to the access to treatment.
NEW LOOK AT OLD MODEL
Mills has not committed to continuing the Opioid Health Homes model, although she has vowed to give Mainers better access to opioid treatment.
“Past reports indicate that the Opioid Health Homes model developed by the current administration has not achieved the success originally promised, and statistics continue to demonstrate that Maine is not effectively combating this crisis,” said Scott Ogden, a Mills spokeswoman. “As with any new administration, the governor-elect will review the efficacy of current policies and programs and make adjustments as needed.”
Katie Fullam Harris, senior vice president of government relations for MaineHealth, the parent company of Maine Medical Center, said the new reimbursement rate is fair, partly because it acknowledges that some patients need more intense treatment than others, and that health care providers need to be paid more for such patients.
Harris said MaineHealth has been implementing the Opioid Health Homes program into its primary care practices over the past two years. She said with better reimbursement rates and more flexibility by the state in how the program can be run, it is set to take off. She said she would prefer tweaks by the Mills administration rather than an overhaul.
“We’ve invested a lot into this system,” Harris said. “I would be concerned if we would suddenly pull the rug out.”
Joe Lawlor can be contacted at 791-6376 or at:
jlawlor@pressherald.com
Twitter: joelawlorph
Send questions/comments to the editors.
