Expanding Authority for MAT, New Initiatives and Next Steps Brad DeCamp SOTA Ohio Mental Health & Addiction Services.

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

Contact information