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Expanding Authority for MAT, New Initiatives and Next Steps
Brad DeCampSOTA
Ohio Mental Health & Addiction Services
Changes in philosophical approach towards MAT “Healthy tension” between abstinence only and
medication
Evolution of medications Methadone, Buprenorphine, Injectable Naltrexone
Changes in reimbursement policies Medicaid as payer of MAT
Changes in service definitions MAT service rolled into Medical/Somatic
Contextual Issues
Diversion concerns Criminal Justice, Law Enforcement
Growth in Naloxone distribution Project DAWN Regional Psychiatric Hospitals (RPHs)
OTP vs. OBOT Bup only OTP vs. Methadone program New rules
Pharmacy Board, Medical Board
Contextual Issues
Growth in methadone programs, client census 9 “Legacy” programs 15 programs More applications in process Client Census
July 2011: 4,700 February 2015: 7,000
Ohio OTPs
OTPs now offering buprenorphine and injectable naltrexone (Two bup-only OTPs)
Client Census - Buprenorphine July 2011: 58 February 2015: 1,200 *
Client Census – Injectable Naltrexone July 2011: 0 February 2015: 70
Ohio OTPs cont.
Enhancing access to Naloxone - $500,000 annually
Legislative efforts to enhance access Also “Standing Order” concept
Addiction Treatment Program Formerly the Addiction Treatment Pilot Program Currently active in 6 counties; Certified Drug Courts Evaluation due later this year from Case Western $2.5 M per year; looking to expand to additional
counties by leveraging Medicaid expansion
Executive Budget
Partnership with DRC Leverage OhioMHAS clinical expertise and
recovery-oriented mission to build on DRC’s success in keeping recidivism rates low and serve more people within the walls of the state prisons
Augment services within the state prison system to increase treatment resources to levels that meets identified need.
Expand resources for outpatient recovery supports and treatment for released inmates.
Executive Budget
Background Statutory Requirements
Non-profit status Time as certified provider
Methadone rules; treatment services rule
MAT has evolved over time
Regulatory Efforts
Recent History Situation in southern Ohio
Enforcement action taken against bup only OTP
Hundreds of patients displaced
Interest from other entities Hospital systems in counties where CDJFS
agencies are transporting to methadone clinics
Regulatory Efforts
TA Request SAMHSA CSAT Division of Pharmacotherapies “Rule Review” product Stakeholder Meeting
State and Federal Regulatory entities – DEA, AG, Pharmacy & Medical Boards
OTPs Non-OTP MHAS Certified Treatment Providers ADAMHS Boards Medicaid
Regulatory Efforts
Day Rate for buprenorphine? Similar concept that exists for methadone Current policy prohibits MHAS programs from
billing for maintenance doses Medicaid is willing to consider approach
Centralized Database/HIE
Regulatory Efforts
As we begin this process…
We have a set of rules of codes that are outdated , do not regulate OTPs evenly
and do not account for the advances in MAT to treat opioid dependence
Current State
At the end of the day, we want…
More modernized set of rules and statutes to govern MAT in the public MHAS system that increases patient access to quality services while maintaining safeguards that prevent diversion
Future State
Not location, location, location… Diversion, diversion, diversion Legitimate concern Harder sell with CJ and LE Good providers are having to adjust their
practice to account for all of the changes that were implemented to remove bad actors
Themes (not Memes)
Large group practices of DATA 2000 physicians How will they be regulated? Are they operating in the spirit of DATA 2000? “Suboxone Hubs” Cash only, multiple physicians
Themes (not Memes)
On the horizon…
Managed Care Not carve out, carve in What does the BH system need to make this
happen?
Continuum of CareWhat does the BH system need to make this happen?
On the horizon…
Bradley M. DeCamp, MPAChief, Behavioral Health Policy and Program Implementation/State Opioid Treatment AuthorityOhio Mental Health & Addiction Services30 East Broad St., 36th FloorColumbus, Ohio [email protected](614) 752-8363
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