MAT in community health centers
- Collection:
- Health Policy and Services Research
- Series Title(s):
- How to pay for it (California HealthCare Foundation)
- Author(s):
- Newman, Sandra, author Fisher, Tammy, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, Calif.] : California Health Care Foundation, January 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Community Health Centers -- economics Insurance, Health, Reimbursement Opiate Substitution Treatment -- economics Opioid-Related Disorders -- drug therapy Reimbursement Mechanisms Buprenorphine -- economics Buprenorphine -- therapeutic use Financing, Government Medication Therapy Management Primary Health Care -- economics Value-Based Purchasing Humans California United States
- Genre(s):
- Technical Report
- Abstract:
- Health centers in California have increasingly focused on designing approaches to identify and treat substance use disorder. One such approach is medication-assisted treatment, which includes the use of Food and Drug Administration approved medications in combination with counseling and behavioral therapies. To integrate medication-assisted treatment (MAT) into primary care, health centers must engage providers and staff, design the clinical model, determine how to identify patients, redesign workflow, and promote cross-discipline coordination. To help pay for the expenses associated with these activities, the US Health Resources and Services Administration's Substance Abuse Service Expansion offered a grant program, and in federal fiscal year 2016, 36 California health centers each received between $300,000 and $400,000. Building on this investment, the Department of Health and Human Services announced in June 2018 that an additional $350 million would be available to support MAT implementation. Health centers are eligible for three categories of funds: $100,000 in base funding, $150,000 in one-time funding to support infrastructure investments, and $250 per MAT patient reported in 2017. While this funding has been crucial to expanding the availability of MAT, health centers are still grappling with how to sustain these programs if grant funding ends. Reimbursement for MAT services is challenging, in large part, because health centers are paid a bundled rate for clinician visits under the prospective payment system (PPS). Services must be provided by a “Federally Qualified Health Center (FQHC) practitioner,” and not all medical professionals involved in MAT are included in this definition (e.g., certified alcohol and drug counselors, registered nurses). Complicating reimbursement is the one-visit rule that prevents California health centers from being paid for both physical health and behavioral health services delivered on the same day. In addition, the PPS bundled rate is inclusive of wraparound services (e.g., care coordination), which may be more intensive for MAT patients and are viewed as critical to the success of delivering MAT in primary care.4 Funding concerns remain central as policymakers and health care providers gain a better understanding of how to expand access to MAT in primary care. This paper summarizes five funding approaches health centers may wish to consider and offers examples where available.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (7 pages)).
- NLM Unique ID:
- 101744630 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101744630