Methadone for MaineCare patients capped at two years under bill
Drug-addicted Medicaid patients would lose coverage for methadone treatment after two years under a bill green-lighted Monday by a legislative committee.
The bill, LD 1840,(see below) limits reimbursement for methadone for opiate addiction to 24 months unless the provider gets approval for longer treatment ahead of time from the Department of Health and Human Services.
The legislation mirrors a similar cutoff placed on Suboxone, another common replacement drug for opiate addicts in treatment, that was approved as part of the last supplemental budget.
The Legislature’s Health and Human Services Committee spent several hours weighing the needs of Medicaid patients trying to get clean against the state’s stewardship of taxpayer-funded health insurance.
MaineCare, the state’s version of the federal Medicaid program, covers roughly three-quarters of all methadone patients in the state, or about 3,500 people.
The bill’s sponsor, Republican Rep. David Burns of Whiting, acknowledged he didn’t have a scientific basis for the two-year cap, but said it seemed reasonable and was in line with the time limit on Suboxone.
“I’m a layperson, I’m not a physician, but it would seem to me after two years of treatment there ought to be enough treatment information there to know if you need to continue, and if so, why shouldn’t that be documented?” he said. “Especially where it’s being covered under MaineCare Services.”
Rep. Linda Sanborn, a Gorham Democrat and retired physician, said the two-year limit fails to recognize that opiate addiction is a disease requiring long-term treatment.
“We’re not looking at setting a length of time on giving people insulin for their diabetes, and we shouldn’t be looking at setting an arbitrary time to treat with methadone,” she said. “It is only because of the stigma that revolves around drug addiction that we’re having this discussion. It has nothing to do with science.”
Recovering addicts take regular doses of methadone to curb cravings as they go through therapy. The dosing and length of treatment varies widely, depending on the individual, and can go on for years.
Heroin addicts generally respond better to methadone, while Suboxone often works better for people addicted to prescription opiates such as Oxycontin, said Dr. Kevin Flanigan, medical director of MaineCare Services.
The committee didn’t discuss how much money the state could save by limiting MaineCare reimbursements for methadone treatment. The two-year cap on Suboxone is projected to save about $600,000 in the next fiscal year.
The cap on methadone would not apply to patients using the drug to treat chronic pain.
Dr. Joseph Py, corporate medical director for Discovery House, which runs methadone clinics in Maine and several other states, said the longer patients are in treatment, the better they do.
“I would love to have people drug-free forever after X amount of time,” he said. “What we know about opiates, since people have been using them… is that has not been the case, time and time again.”
The committee voted 8-2 in favor of the methadone bill, which now goes to the full Legislature for a vote. Additional language about MaineCare reimbursement for transportation to methadone clinics, which is included in a separate bill, was removed.
Source:
Bangor Daily News
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §3174-SS is enacted to read:
§ 3174-SS. Methadone reimbursement limitations
Effective January 1, 2013, the following limitations apply to reimbursement under the MaineCare program for methadone for the treatment of addiction to opiates as defined in Title 17-A, section 1101, subsection 7. Services must be provided at the clinic located closest to the home of the member and services must be limited to a lifetime maximum of 24 months, except that reimbursement may be provided for longer than 24 months if prior authorization is received from the department.
The department shall adopt rules to implement this section. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 2. Review of options. The Department of Health and Human Services shall review the options that the Office of MaineCare Services has under federal law to restrict transportation services reimbursement related to methadone treatment under the MaineCare program to encourage efficient use of transportation services and to discourage and penalize fraud. The review must include a study of laws in other states restricting transportation reimbursement to a certain number of times per week or times per lifetime and must include a study of limitations based on one-way or round-trip reimbursement and a requirement to use the provider whose office is the closest to the MaineCare member's home. The review must provide information on exception and appeals processes and estimated savings for options judged by the Office of MaineCare Services to be viable for the State. The department shall report to the joint standing committee of the Legislature having jurisdiction over health and human services matters by December 15, 2012 on the department's findings and recommendations as a result of this review.
SUMMARY
This bill proposes to limit MaineCare reimbursement for methadone for the treatment of addiction to opiates to a lifetime maximum of 24 months, effective January 1, 2013. The bill authorizes reimbursement for longer than 24 months if the Department of Health and Human Services provides prior authorization. The bill proposes to limit services to the clinic closest to the home of the member. The bill requires the department to review the options to restrict transportation services reimbursement for methadone treatment under the MaineCare program to encourage efficient use of transportation services and to discourage and penalize fraud. The review must include a study of limitations based on one-way or round-trip reimbursement and a requirement to use the provider whose office is the closest to the MaineCare member's home. The department is required to report to the joint standing committee of the Legislature having jurisdiction over health and human services matters by December 15, 2012 on the department's findings and recommendations as a result of the review.
View bill
click here for status of LD1840
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