September 26, 2011
NQF Standards-Consider Adoption
Document Review
2012 Advocacy Agenda – Review and approve language
Ideal Treatment System – review and approve language
Independent Provider Position Statement (tentative)
Proposed Legislation
Utilization Management Decisions: Legislation to ensure utilization management decisions are based on
professional judgment related to all levels of care and criteria for admission, continuing care and discharge from services. This will ensure decisions are made based on medical need and not short term budgetary decisions.
Published Data: Require Payors (MCOs and/or ASOs) to publish quarterly data regarding how many individuals in each level of care and in each region of the state have received addiction services.
Board of Professional Counselors and Therapists Collaboration: Discuss potential legislation related to credentialing and Board of Professional Counselors and Therapists.
Legislator Meetings
Review Forms
Fact Sheets
Legislative Visit Form
Follow-up Contact Form
Calendar of Meetings
Mission
The Maryland Addictions Directors Council advocates for quality addictions services that promote healthy individuals, strong families and thriving communities.
Vision
People in need of services will have timely and easy access to high-quality services at the appropriate level to meet their needs.
A continuum of services will be available that begin with prevention and include intervention, treatment, recovery, support and wellness. Treatment will be available and accessible at all American Society of Addiction Medicine (ASAM) levels of care for substance use disorders.
People will be aware of services and will access them at an earlier stage, without the barriers of shame or inability to pay. Access to the right service at the right time will reduce costs and increase quality and availability of services.
Public policy will address treatment for substance use, co-occurring disorders and process addiction as any other health issue. Laws will include alternatives to punishment and provide more opportunities for the courts to choose treatment solutions.
People in need of services will be treated by highly qualified specialists who are recognized and utilized as a critical part of the health care team. Multiple levels of certification will correspond to similar levels in the medical profession. Professionals will be knowledgeable and highly skilled, based on their education, certification and access to ongoing professional
development.
Access to treatment for all who need it will benefit society and the economy by boosting
worker productivity, reducing crime and incarceration costs, improving infant and child health, advancing achievement for children and youth, and strengthening families and communities.
Workforce: Advocate for respect and support of professionals who provide
prevention, intervention, treatment and recovery services for persons with substance use disorders and for honoring and utilizing the judgment of these professionals regarding appropriate levels of care for those with substance use disorders.
Advocate for amending laws and regulations to facilitate the development of a strong and effective provider network and workforce by removing legal barriers related to credentialing and program operation.
Advocate for full funding of the ADAA budget and for continued support of block grant funding to ensure that all ASAM levels of care are funded and that those without Medicaid or other insurance have access to treatment.
Advocate for transparency in Medicaid funded managed care organizations regarding medical necessity criteria and public access to utilization and outcome data.
Advocate for procedures that would ensure that managed care organizations and insurers honor the professional judgment of substance use disorder professionals regarding appropriate ASAM levels of care.
Affordable Care Act: Ensure that substance use disorder professionals have genuine and meaningful input into the implementation of the Affordable Care Act and the development of the health benefit exchange in Maryland.
Advocate in favor of the development of a robust and large Health Benefit Exchange.
Advocate for incentives and policies that address the workforce shortages and challenges as health care reform is implemented.
Support the new role of public substance use disorder providers in the context of health care reform.
Advocate for health care reform policies that address gaps in coverage for the safety net population.
Advocate in favor of person centered health homes and for Maryland to apply for
federal grants to support that program.
Behavioral Health Integration: Ensure that substance use professionals have genuine and meaningful input into the transformation of the substance use disorder and mental health systems in Maryland and the provision of
integrated behavioral health services.
Support policies that facilitate the provision of services to dually diagnosed individuals.
Support aligning laws and regulations to remove undue barriers.
Ensure that providers who serve only persons with substance use disorders do not have additional burdensome requirements.
Provide information and support to consultants studying the integration of
behavioral health in Maryland and support legislation consistent with our
goal to provide accessible and effective treatment to those with substance use
disorders.
The Ideal Substance Use Disorder Treatment System in Maryland
Every Marylander, with or without insurance, needing substance use disorder treatment must have easy access to all appropriate levels of care based on their assessed needs.
An ideal treatment system will contain the following important elements:
▪ A comprehensive continuum of care that is available at all levels of care based on medical necessity.
▪ Use of screening and prevention services in primary care settings.
▪ An environment that supports technology and innovation.
▪ A culture that is responsive to change.
▪ A strong, professional, well-trained and culturally competent workforce.
▪ Increasing numbers of professionals in the workforce at all levels to meet the needs of the community.
▪ High quality services provided to patients demonstrated by high quality outcome data.
▪ Access to quality substance use disorder treatment for all those in need of treatment.
▪ The ability of an individual to maintain their provider even when insurance changes.
▪ High-quality, integrated behavioral health services
(substance use disorder and mental health).
▪ Seamless integrated behavioral health and somatic health services.
▪ Information sharing among health providers to support quality patient care.
Important elements that serve as the foundation of an ideal treatment system:
▪ Medication assistance for mental health and addiction problems should be available to all clients based on an individual assessment in the local jurisdictions.
▪ Every jurisdiction should provide the basics of evidence-based recovery practices.
▪ Health Departments must be allowed to provide direct and contractual services based on local decisions regarding the best manner to meet the needs of their citizens.
▪ Citizens with private insurance must be able to access health department programs offering a sliding scale.
▪ Development of an easy to use system for collecting and sharing useful outcome data.
▪ Transparency and open access to data and ability to produce useful reports at the provider, local and state level.
▪ Regulations that support the provision of quality services and not create unnecessary barriers.
▪ Professional credentialing requirements should support the expansion and growth of substance use disorder professionals at all levels.
▪ Availability of small substance use provider practices, as well as, larger treatment providers.
Elements related to the implementation of the Affordable Health Care Act
▪ Person Centered Health Care Homes for persons with substance use disorders and other health needs should be implemented to support integrated care.
▪ Behavioral health benefits must be provided in parity with medical and surgical benefits.
▪ The Essential Benefit Package should include coverage for all levels of care.
▪ The Health Benefit Exchange should be robust and provide referral services, as well as, standards for participation.
▪ Strong participation in the Health Benefit Exchange by a variety of insurers should be encouraged.
▪ Individuals who move from Medicaid to Health Benefit Exchange insurance should be able to maintain the same treatment provider and level of care without disruption.
▪ Block grant funding should be maintained for safety-net population and services that are not covered by Medicaid.
▪ Behavioral health should fully participate in the development of the Health Information Exchange.
▪ Electronic record systems should meet meaningful use criteria.
General Funding Principals:
▪ The provider community is in support of a hybrid funding system that maximizes dollars from fee-for-service and grant dollars that support all the important components of an ideal treatment system.
▪ Grant funds will ensure the continuation of many important community services including criminal justice and women with children programs.
▪ There must be an elimination of profit based on denial of services.
▪ Moving exclusively to a fee-for-service model is not recommended as it would change the focus of treatment programs and impact treatment decisions.
▪ The State should take actions necessary to make use of federal funds available as a result of the Affordable Care Act.
Specific Funding Recommendations and Considerations:
▪ Outpatient/intensive outpatient substance abuse services covered by Maryland’s Medicaid program should be provided on a fee-for-service basis, with additional fee-for-service dollars available for the uninsured.
▪ Continued grant funding is essential to treatment access to all appropriate levels of care and to assure quality of care, thus creating/continuing a “hybrid” model with both grant funding and fee-for-service features.
▪ All providers accessing public funds in a hybrid model (combination of grant funding and fee- for-service) should be required to access all other funding before paying for needed services via grant dollars.
▪ Residential care must continue to be offered at current levels, as an important component of the system.
▪ The state must expand its commitment to adolescent substance abuse programs.
▪ Tele-psychiatry programs, and other similar technology-based services, must be reimbursed in a manner consistent with traditional counseling approaches.
▪ Treatment providers should be given substantial input into the rates established for services;
and rates for all levels of care must enable providers to adequately cover the costs of providing each level of care.
▪ Standardized clinical placement criteria should be used by the ASO to authorize
services for each level of care and providers should have a significant voice in length of stay decisions.
▪ Investment should be made in purchasing electronic record and billing systems that meet meaningful use requirements that allow access to federal incentive funds.
▪ Investment should be made in person centered health care homes.
Accountability Recommendations & Considerations:
▪ State agencies and insurance providers must be held to the same level of accountability as treatment providers, with similar data collection and publishing requirements, along with objective measures that demonstrate success in accomplishing the goals of the treatment system in Maryland.
▪ Regulations developed to integrate behavioral health should not create additional burdens on current providers of behavioral health services.
