Baltimore has been hard-hit by the opioid epidemic, with at least 20,000 of the city’s 620,000 residents actively using heroin and far more abusing prescription painkillers. About 10,000 others are receiving treatment at freestanding or hospital-based treatment centers like REACH Health Services, according to Behavioral Health System Baltimore, a nonprofit that distributes funding to opioid addiction treatment centers, Stateline reports. To encourage the centers to offer more counseling when patients need it, Maryland’s Medicaid agency is changing the way it reimburses them. Rather than paying a flat rate for all patients, the federal-state health care program for the poor in March will begin to pay providers for as much counseling and related medical services as are needed for individual patients. At the same time, the state will lower its traditional per-person weekly reimbursement rate for opioid treatment centers.
The new fee structure is similar to schemes developed in New York and California. New Jersey is moving in the same direction. The shift reflects a growing consensus among medical researchers that patients who receive a combination of addiction medication and counseling fare better than those who receive only one or the other. “The evidence is clear,” said Dr. Leana Wen, Baltimore’s health commissioner. “Addiction is a disease, treatment exists and recovery is possible. Medications, including methadone and buprenorphine, combined with counseling are proven to lead to better outcomes than treating opioid addiction with medication alone. Counseling allows those in recovery to develop the tools and coping skills they need to prevent relapse.” Some in Baltimore’s opioid treatment field worry the new pricing structure will make it difficult to stay in business, much less expand to meet the growing need. The Rev. Milton Williams of the Turning Point Clinic, which dispenses daily methadone doses to more than 2,800 patients in East Baltimore, said most people who come to his center don’t want counseling.