TREATMENT PANEL September 19, 2013 Treatment for substance use - PowerPoint PPT Presentation

ACCOUNTABILITY SUMMIT “Turning the Curve on Opioid Abuse in Bernalillo County” Harris Silver, M.D. Consultant, Health Care and Drug Policy Analyst Clinical Assistant Professor Department of Family and Community Medicine University of New Mexico Health Sciences Center TREATMENT PANEL September 19, 2013

Treatment for substance use disorders The Savings  Substance Abuse and Mental Health Services Administration (SAMHSA): Treatment saves $12 for every $1 spent  $7 in criminal justice costs  $5 in medical costs

American Society of Addiction Medicine (ASAM) Patient Placement Criteria

“Treatment Does Not work”  Inadequate length and intensity and/or inappropriate treatment – “one size fits all” does not work – ASAM criteria not applied  Inexperienced or poorly trained counselors  Lack of aftercare after treatment  Lack of social supports after treatment  Lack of bridging of care and social supports after treatment during incarceration  High rate of co-occurring mental disorders (at least 60%) – not diagnosed and/or treated

Mental Health Parity and Addiction Equity Act (Federal Law – 2008) Senators Pete Domenici and Paul Wellstone  MHPAEA : no discrimination in treatment of mental disorders and SUDs compared with medical and surgical disorders – same scope of treatment as medical/surgical disorders  Legal interpretation: if medical and surgical disorders get full continuum of care, then so do mental and substance use disorders  No provisions for enforcement since “implementation” in 2010 – enforcement has been through victorious lawsuits

Parity Implementation Coalition MHPAEA Supporters

Parity Implementation Coalition Legal Interpretation of MHPAEA  Illegal to not offer full continuum of SUD care including short-term and long-term residential treatment when offer full continuum of care for medical/surgical disorders  “Fail - first” policies are illegal (i.e., not initiating treatment based on ASAM guidelines)  Onerous pre-authorizations are not allowed for addiction medications if not done for routine medications for medical/surgical disorders

MHPAEA Compliance Requirements  All Medicaid plans beginning in 2014  All plans in insurance exchanges  All plans in individual and family markets  All employer-sponsored plans with more than 50 employees if they offer any mental health and SUD benefits

Potential Recommendations  Creation of comprehensive treatment system in Bernalillo County. Funding sources? Could the Assessment Center serve as the nucleus?  Develop a comprehensive inventory of treatment services to help better understand gaps.  Expansion of resources for the full continuum of addiction treatment services to not only meet the current need but the expanded need due to increased access from health reform.  Have treatment access through Medicaid and commercial insurers that utilizes the ASAM patient placement criteria and is in compliance with the Mental Health Parity and Addiction Equity Act.

Potential Tracking Indicators for Treatment  NUMBER OF OVERDOSES  # hospitalizations for OD with opioid involvement  # ED visits for OD with opioid involvement  # of slots available for all levels of treatment (e.g., detox, IOP, residential, transitional living)  # of treatment admissions for each level of care  # of births with neonatal abstinence syndrome