Methadone and Suboxone providers in Maine are warning that a proposal by the state Department of Health and Human Services could exacerbate the opioid crisis in Maine and potentially drive some drug treatment clinics out of business.
Even as drug overdoses in Maine show no sign of letting up and access to effective drug treatment remains limited, DHHS is proposing changes for treatment providers that some say could move the state backward, including additional requirements for counseling and record keeping and more responsibilities for medical directors. The proposal does not include additional funding.
State Health Officer Dr. Christopher Pezzullo says the rule changes are consistent with guidance from the federal Substance Abuse and Mental Health Services Administration.
“What’s important from MaineCare’s perspective is that the care that patients receive in methadone treatment facilities is at the highest level and it matches what federal SAMSHA recommends,” he says.
Eric Haram of the Addiction Recovery Center in Brunswick, which provides Suboxone treatment along with individual and group therapy, says the proposed changes may be well intentioned but they ignore one of the recommendations of a state task force convened last year to address the state’s heroin epidemic: getting more people into medication-assisted treatment. That means methadone and Suboxone.
The task force included treatment providers and members of law enforcement.
“To date there hasn’t been any movement yet to expand access to treatment for opiate dependence or reduce wait times that we know to be such a contributor to the current overdose death rates,” Haram says.
Jim Cohen, who represents the state’s 10 methadone providers, says not only are the proposed rules misguided, but they put the clinics in a precarious position.
“There is a risk, and it is not a small one, that because providers are on the edge of financial viability today, that the expansions of requirements without any funding changes is very likely to result in the closure of those clinics that provide services to Medicaid patients,” he says, speaking about the proposed rule change at a public hearing Monday morning in Augusta.
Cohen says methadone clinics treat about 4,000 patients statewide, but the majority, about 3,000, are MaineCare patients. He points out that the clinics are already operating with a MaineCare reimbursement rate that was cut by the Legislature six years ago. An effort to restore it to pre-2010 levels failed to receive legislative support this year.
Meanwhile, the state has eliminated young, able-bodied adults from the MaineCare rolls and imposed a two-year cap on methadone and Suboxone treatment without prior authorization from a doctor.
“It’s become increasingly difficult over the years for our clients to get medication-assisted treatment because of some changes in policies that have been made,” says Jack Comart of Maine Equal Justice Partners, who represents low-income clients. “I don’t understand why, in the middle of this crisis, the department is taking steps that will make it more difficult for people to obtain this service rather than more accessible treatment for them.”
Pezzullo says the LePage administration supports evidence-based treatment for substance-use disorder, but he says Maine already has one of the highest per-capita rates of methadone and Suboxone treatment in the country. The proposed rule, he says, is not intended to address access but rather quality of care.
But Cohen says the changes appear to be singling out methadone and Suboxone treatment for additional requirements. They do not cover abstinence-based treatment, detox or residential care.
“The federal government has made clear that states or agencies, in their words, that ‘discriminate’ against medication-assisted treatment risk losing federal funding for a range of services,” he says. “And this clearly adds standards to medication-assisted treatment that are not being added to other modalities.”
Pezzullo says the proposal will require approval by the federal Center for Medicaid Services.
