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Expansion of residential drug treatment reimbursement under way

May 13th, 2017 by WCBC Radio

Maryland expansion of residential drug treatment reimbursement advanced today, as the Medicaid program sent guidance materials to providers in advance of the July 1 implementation. The expansion, solidified in the program’s federally approved waiver, will enable providers to receive previously denied reimbursement, a statutory obstacle that contributed to the opioid crisis here. 

“The expansion of this reimbursement to residential treatment providers could not come at a better time,” said Health and Mental Hygiene Secretary Dennis R. Schrader. “We are so grateful for the support Gov. Larry Hogan provided for our Medicaid waiver application that featured this reimbursement as a linchpin of the policies put in place to combat the opioid epidemic.”

Medicaid’s expansion of treatment reimbursement and similar policies coincide with Governor Hogan declaring a state of emergency in Maryland and forming the Opioid Operational Command Center, which works to improve state and local agencies’ collaborations to raise awareness and to save lives. 

The IMD Waiver, approved by the U.S. Centers for Medicare & Medicaid Services on December 27, 2016, will provide Medicaid reimbursement for inpatient, 8-507 treatment services. This will increase provider capacity and Marylanders’ access to these services. The federal IMD exclusion has prohibited Medicaid reimbursement for adults between the ages of 21 and 64 who are receiving services provided in a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care and treatment of individuals with mental diseases.  

Because of this non-payment policy, many Medicaid enrollees with acute psychiatric and addiction treatment needs have been referred to hospital emergency departments and general acute care inpatient units, rather than smaller, community-based specialized providers with expertise to care for these individuals. The IMD exclusion waiver is part of a series of innovations being employed by the Medicaid program to combat the opioid epidemic. 

In partnership with all eight of its HealthChoice managed care organizations, the program Maryland Medicaid is working to reduce opioid misuse, dependence, overdose and death in both Medicaid fee-for-service and HealthChoice managed care programs.

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