More substance abuse treatment options under Medicaid expansion, but other issues still in flux, state officials say

09/14/2015 05:58 PM

FRANKFORT — Gov. Steve Beshear’s decision to expand Medicaid eligibility via executive order may not have won him many fans among conservative lawmakers, but it has opened new opportunities for drug addiction treatment, state officials told lawmakers Monday.

The Senate Bill 192 Implementation Oversight Committee focused largely on substance abuse services provided by Medicaid. Part of that bill focused on providing greater access to treatment for heroin addicts.

Under the traditional model, addiction treatment options provided by Medicaid were available to pregnant women, the elderly and disabled, and children with Early and Periodic Screening, Diagnostic and Treatment benefits, Department for Medicaid Services Commissioner Lisa Lee said. With the expansion, all adults at or below 138 percent of the federal poverty level are eligible for such services.

What’s more, the Medicaid provider network for drug treatment increased since Jan. 1, 2014, in anticipation of the program’s expansion, with licensed psychologists, professional clinical counselors, marriage and family therapists, and clinical social workers now covered in the program, Lee said. Community mental health centers had been the only entities to provide mental health and substance abuse treatment in pre-expansion Medicaid, and licensed clinical alcohol and drug counselors will join the provider network Oct. 1, she said.

“We knew that were expanding Medicaid,” Lee said. “We had a workforce-development study conducted by Deloitte, and we knew that we had a few areas of improvement, one of those being behavioral health services, so on Jan. 1, 2014, we expanded the provider types that could actually deliver behavioral health services.”

There is a conflict between current Medicaid standards and a key provision of SB 192, however. Rep. Joni Jenkins, D-Shively, asked about issues regarding Medicaid’s coverage of naloxone, an overdose-reversing drug more readily available to law enforcement and emergency responders due to SB 192.

The problem isn’t with the drug, but rather the way it’s delivered, said Dr. Allen Brenzel, medical director for the Department for Behavioral Health, Developmental and Intellectual Disabilities.

“At this point the form that’s preferred is a nasal administration of that medication, so there’s a form now that involves a pen like an EpiPen that you would stick in someone’s leg and that you would pull a plunger and that would inject,” Brenzel said. “That tends to have, in sort of my experience, some less acceptance from those who might administer it because it involves a needle, and so the preferred form that we’re most supporting is the nasal administration. However, it’s not FDA (U.S. Food and Drug Administration) indicated. There’s not an FDA-approved nasal preparation at this point.”

“We can’t pay for with a Medicaid prescription benefit a nasal form of that,” he continued. “We can take that other form and put it with a nasal bulb that screws onto the syringe, and so for $50 we can buy that old medicine, we can put it with a nasal tip, which costs 25 cents, and we can make that available. However, at this point Medicaid can’t put that on its formulary, so the FDA is expediting approval of a nasal preparation.”

The oversight panel also discussed problems directing emergency room patients to drug treatment. SB 192 mandates that patients admitted to ERs for overdoses be informed of addiction services, and hospitals can contact treatment centers for the individuals and community mental health centers able to provide an on-call service for the local ERs.

Rep. Denny Butler, D-Louisville, said that with some life-saving options in SB 192, such as the wider availability of naloxone to first responders and the “Good Samaritan” provision that legally protects those who suffer from or report drug overdoses, there should be a greater emphasis on directing overdose patients to rehab.

“It’s frustrating for myself and some of my colleagues, if not all of them, the breakdowns of this warm handoff,” he said.

Brenzel said hospitals and ERs could provide a greater emphasis on screening, brief intervention and referral for treatment while providers could add on-site mobile crisis units that visit overdose victims in recovery.

“That’s ideal because they could say, ‘Hey, I work for XYZ provider. When you come to the clinic, you’ll see me or you’ll see Cathy, and here’s what Cathy looks like,’” Brenzel said. “These are all things that increase the yield of someone who leaves the ER actually coming to the treatment setting.”

Hospitals are also able to create treatment programs within their organizational structure, he said, and community mental health centers are being encouraged to inform hospitals and ERs of their services, said Mary Begley, commissioner of the Department for Behabioral Health, Developmental and Intellectual Disabilities.

That would require on-call staffing 24 hours a day, but Begley said such services would provide a greater probability of success in reaching addicts who overdose.

“We’ve seen one of our community mental health centers actually put more dollars into marketing to be able to go out to facilities such as that as well as the law enforcement to let them know what services they’re providing,” she said.


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