This section lists the short-term recommendations of the Task Force. By definition, short-term means actions that can be considered for implementation and substantially accomplished during 2001. Recommendations that require a longer period to achieve have been placed in the “legacy” or long-term section of the Report.
There is agreement among Task Force members that the following recommendations are critically important. Decisions that delay implementation, or that divert attention from these items, are likely to harm citizens and impede improvements to the substance abuse treatment system.
1. Expansion of Detoxification and Residential Treatment.
In addition to the South Jersey Initiative that will add 50 beds for adolescents in the Summer of 2001, DHSS/DAS should make every effort to expand the capacity of existing treatment providers to deliver detoxification, short term and long term
residential treatment. The target population is primarily persons who are medically indigent. The purpose is to assure access to persons who meet the ASAM placement criteria for these levels of care. Physical plant capacity of existing facilities, i.e. beds or wings that are empty and that are not being purchased or underutilized currently are the target for this effort. The expansion is intended to add to total capacity for publicly funded populations and is not intended to displace capacity from another purchaser to DHSS/DAS. In some instances it may be necessary to expand or modify a physical plant to accommodate additional beds. Service capacity should also be expanded for opiate addicts including expanded opioid maintenance therapy with methadone, LAAM and future use of buprenorphine. Ensure that clients receiving methadone, LAAM and other medications are treated (as needed) for other substance abuse and psychiatric problems.
Primary Responsibility: DHSS/DAS and Providers of Residential Treatment Services. 2. Establish a Forum for Analysis and Exchange Between Employers, Managed Care
Organizations and Treatment Providers and Other Stakeholders.
Creation of a forum for productive exchange between employers, managed care
organizations, managed behavioral health acre organizations, substance abuse treatment providers, family members, and other stakeholders has the potential to resolve several issues identified by the Task Force. These problems include difficulty of insured persons in
accessing substance abuse treatment; limited benefit plans; denials of care for the appropriate level of care; the inability of some providers to secure contracts with HMOs and MBHCOs;
and lack of agreement on criteria that should be used to determine medical necessity, level of care, and treatment authorization.
Primary Responsibility: Deputy Commissioner/DHSS, DHSS/Office of Managed Care, DAS and Department of Insurance.
3. List and Compare Rates Paid by All Public Purchasers.
This task, to be completed in the short-term, provides information to purchasers, providers and other stakeholders. The Task Force recommends that a list of all fee for service rates paid to public purchasers be prepared, on a service by service basis, and that – to the extent
possible - rates paid by private purchasers be added to the list. This action could encourage consideration by all public purchasers to pay the same rate for the same substance abuse treatment services. It will also allow comparison in late Fall of 2001 between providers costs of care and rates of payment and permit analysis of the various financial incentives used by public and private purchasers.
Primary Responsibility: Treatment Providers Cost Subcommittee and Director of Treatment and Managed Care, DHSS/DAS.
4. Remove the “Economy of Scale” Adjustment in DHSS/DAS Slot Rates.
The existing slot rates paid by DHSS/DAS contain a factor that reduces the annual slot rate by 10% when the size of the program exceeds 40 residential, 150 methadone or 75 outpatient slots. The Task Force recommends that this “economy of scale” factor be eliminated since providers feel current reimbursement is too low to provide quality care. The revised rates should be inspected following completion of the Capital Consulting cost study in the fall of 2001.
Primary Responsibility: DHSS/DAS.
5. Rates of Payment for Medicaid Outpatient Services.
Despite the fact that Medicaid is one of the State’s largest payers, nonetheless, Medicaid rates for outpatient care established in 1984 have not been revised since that time. Treatment providers report that they limit the number of Medicaid recipients that they are willing to serve, as they lose money due to the inadequacy of the rates. The recommendation is to increase the existing Medicaid federally matchable outpatient rates to the rates used for Work First New Jersey’s Substance Abuse Initiative. The revised rates should be inspected following completion of the Capital Consulting cost study in the fall of 2001.
Primary Responsibility: Division of Medical Assistance and Health Services/DHS, Treatment Providers Cost Subcommittee, Director of Treatment & Managed Care, DHSS/DAS.
6. Substitute State Funding of DHSS/DAS Needs Assessment Studies when and if Federal funding is concluded.
These studies are key to effective resource allocation, outcomes studies and long range prevention and treatment planning.
Primary Responsibility: DHSS/DAS.
7. Quality Management Improvement Package # 1.
Includes establishing Centers of Excellence, completing a candid assessment of the quality of treatment, and assuring the ability of licensed treatment programs to meet the diverse needs of special populations, e.g. pregnant addicts, adolescents, women with children, Asians, persons of Hispanic origin, etc.
Primary Responsibility: DHSS/DAS, Providers, DHS, DOC, L&PS Various Administrative Items
The following recommendations can be accomplished in an ongoing manner and can be achieved within existing fixed costs.
a) Resolve the regulatory conflict between DHSS and the Department of Corrections (DOC) concerning smoking at treatment facilities.
Primary Responsibility: DHSS/DAS, DOC and Providers.
b) Involve treatment facility directors more fully in DHSS/DAS development of new mandates or regulations, and in a legislative review process.
Primary Responsibility: Assistant Commissioner, DHSS/DAS and Executive Directors of treatment facilities.
c) Consider national accreditation in lieu of or in conjunction with state licensure of substance abuse treatment programs.
Primary Responsibility: Director of Licensure & Grants Monitoring, DHSS/DAS, trade association representatives of treatment agencies.
d) Consider 3-year contracts for substance abuse treatment services, and Chapter 51 county grants.
Primary Responsibility: DHSS/DAS, Other State agencies that purchase substance abuse treatment services, counties, trade association representatives of treatment agencies. e) Secure entry level positions for recovering persons as they work on counselor
certification.
f) Continue the current mix of reimbursement mechanisms used by DHSS/DAS until the Cost Study is complete and the management implications of any possible rate changes are considered.
Primary Responsibility: DHSS/DAS.
g) Implement a revised policy regarding current restrictions on grantee’s use of cash reserves.
Primary Responsibility: DHSS/DAS and Treatment Providers.
h) Compile an inventory of safe, available, affordable, sober housing to ease client reintegration into communities
Primary Responsibility: DHSS/DAS, Department of Community Affairs (DCA) and Department of Human Services (DHS)
(i) Review and analyze the effectiveness of drug treatment providers to serve clients with HIV/AIDS and determine the impact on transmission. Use this rationale to
determine whether there should be a prioritization of treatment for clients with
HIV/AIDS. Increase education regarding HIV/AIDS treatment regimens and providers’ role in medical management of these diseases.