H.R. 6: SUPPORT for Patients and Communities Act: The Substance Use‐Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act

Section 2005. Medicare coverage of certain services furnished by opioid treatment programs. This provision expands Medicare coverage to include Opioid Treatment Programs (OTPs) for the purposes of delivering Medication‐Assisted Treatment (MAT) to expand access to treatment options for Medicare beneficiaries. Currently, OTPs are not recognized as Medicare providers, meaning that beneficiaries receiving MAT at OTPs for their opioid use disorders must pay out‐of‐pocket. In 13 states, the highest rate of opioid‐related inpatient stays is among the over 65 population. Under the provision Medicare will pay the outpatient OTPs through bundled payments made for wholistic services, including necessary medications, counseling, and testing.     

DEA,SAMHSA relax OTP/OBOT regulations due to COVID‐19

Opioid treatment programs (OTPs) that dispense methadone got a fast and clear reprieve from federal authorities last week in the face of COVID‐19. The Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued policies that give OTPs flexibility in take‐homes, limiting the frequency of face‐to‐face contact and opportunities for transmission of COVID‐19. There is also greater flexibility for office‐based opioid treatment (OBOT) with buprenorphine.     

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New Treatment Money for West Virginia Providers under Justice Reinvestment Act OTPs Confront Price Challenges as They Diversify Drug Options Documentary Trailer Outrages W.Va. Town SUDs Mentioned at White House Meeting on Mental Health $26.9 Million Increase for SA Services in Texas Budget NIAAA Study Shows Varenicline Reduces Alcohol Consumption BFC and Hazelden Pursue Alliance State News Names in the News Resources Coming up     

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Senate Appropriations Committee Marks up SAMHSA FY 2014 Spending For Parity to Fulfill Promise, CEOs See Fight on Many Fronts AATOD Comments on SAMHSA Draft Guidelines for OTPs Optum, State Suspend N.M. Provider Payments Pending Probe SAAS, Legal Action Center and National Council Form Strategic Alliance Opioid ODs Increasing at a Faster Rate among Women than Men State News Coming up     

Starting a new OTP and leading clinical services for an OBOT: Talbott

Zachary Talbott, who founded Counseling Solutions Treatment Centers in 2015 and operated opioid treatment programs (OTPs) in Chatsworth, Georgia, and Murphy, North Carolina (see ADAW, August 17, 2015), which were then acquired by BayMark Health Services in August 2018 (see ADAW, Sept. 10, 2018), and who ultimately set his sights on returning home to Maryville, Tennessee, had a plan. Anyone who knows him knew he would. He recently joined ReVIDA Recovery Centers as their director of clinical services to develop, implement and oversee a comprehensive behavioral health program within the company's continuum of care.     

AATOD and NAMA praise DEA methadone van proposal

The two big organizations representing opioid treatment programs (OTPs), on the one hand, and methadone patients, on the other, were unified in cheering the long‐awaited proposal by the Drug Enforcement Administration (DEA) to allow clinics to transport the medication to patients via “conveyances,” or vans. These vans would obviate the necessity of traveling, sometimes for hours, to get medication. Both the American Association for the Treatment of Opioid Dependence (AATOD) and NAMA Recovery (NAMA) sent official comments to the DEA, citing three ways the vans can be used.     

Briefly Noted

A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention published in Drug and Alcohol Dependence this month, based on a national survey of 46 opioid treatment programs (OTPs), concludes that buprenorphine and Vivitrol are not given equal footing with methadone as medications used by OTPs. All three are approved by the Food and Drug Administration for the treatment of opioid use disorder. Barriers, including costs, are identified. In addition, the report charges that services for HPV, HIV and other infectious diseases are not adequately integrated into OTPs, and that the reach of OTPs should be expanded. The report, “Characteristics and Current Clinical Practices of Opioid Treatment Programs in the United States,” is by Christopher M. Jones and colleagues; Elinore F. McCance‐Katz, M.D., Ph.D., is the senior author.     

Mallinckrodt donates hand sanitizers to all OTPs

Mallinckrodt, a pharmaceutical company that makes methadone and buprenorphine for opioid treatment programs (OTPs) as well as many other medications, started out making hand sanitizer for its own plant employees when the pandemic began this winter. It wasn't long, however, before the company recognized that OTPs needed hand sanitizer — like everyone else, they were unable to get it. So last month, the St. Louis–based company started distributing it — for free — to all OTPs, not only its customers.     

OTPs look toward criminal justice as major area for growth

Opioid treatment programs (OTPs), formerly known as methadone clinics, were set for a dramatic expansion several years ago when the opioid crisis was growing at an increasing rate, but now, that expansion is targeted toward one population of patients in particular: those in the criminal justice system. In particular, people who are in prison and jail are most likely to need — and not receive — treatment for opioid use disorder (OUD), and the nation's OTPs are ready to help.     

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SAMHSA Issues Final Rule Allowing OTPs to Dispense Take‐Home Buprenorphine Vt. Hospital Program Manages Planned and Unexpected Growth Program to Screen Staff for Relapse Risk after DUI Tragedy Where Recovery Residences Fit in Health Care Reform Bill White ‘Retiring’ but Will Continue Work in the Field Study: Binge Eating in Teens Associated with Initiating Drug Use Resources Obituary Coming up     

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Parity Final Rule Even Stronger than IFR, Protecting Residential Noncompliant Health Plan Example An Active Presence Online Can Counteract Negative Comments Who Must Provide Coverage under the MHPAEA Law — Not the Final Rule Focus on Recovery, Ongoing Stigma Problems for OTPs at AATOD New Casinos, New Problem Gamblers for New York NIAAA Trial Finds Promising Results for Gabapentin Walter Ginter Presents Advocate and Patient View at AATOD Briefly Noted Obituary Names in the News Coming up     

Briefly Noted

A federal audit of opioid treatment programs (OTPs) — methadone clinics — in New York City found that of 115 random sample claims, 35 did not comply with Medicaid requirements, and that of 598 claims in a non‐random sample, 299 were billed in error. Extrapolating these errors, the federal Department of Health and Human Services (HHS) says the state improperly claimed at least $39.3 million in the federal share of Medicaid reimbursement, and owes that money back. Improper claims were mainly due to failure to record patients in the central registry, which exists to make sure patients aren't enrolled in multiple OTPs (18 of the 35 noncompliant claims). This was not an audit alleging fraud. Extrapolation as an accounting method for OTPs, where patients often come in every day, so that each patient has more than 300 claims a year, is questionable, but OTPs are used to this even in state audits. In other words, one OTP patient comes in six days a week, with six claims, and the database balloons. “You're extrapolating over our universe, and our universe becomes large because people come in for medication,” said Allegra Schorr, president of the Coalition of Medication‐Assisted Treatment Providers and Advocates, a New York–based membership organization, and board member of the American Association for the Treatment of Opioid Dependence. “When you're just trying to get money, this counts,” said Schorr. “They hit the lottery when it comes to an audit because of that extrapolation.” However, Schorr, who is also an owner and vice president of West Midtown Medical Group, a Manhattan‐based group that was the first OTP to dispense buprenorphine in New York state, stresses that compliance is always important. “It's critical that there is oversight,” she told ADAW. Meanwhile, the state is reviewing the audit and will respond. “The Office of Addiction Services and Supports (OASAS), in partnership with the NYS Office of Medicaid Inspector General, intends to review the specific findings of this audit cited by OIG [Office of Inspector General] to verify its accuracy and to determine an appropriate course of action,” said Evan Frost, spokesman for OASAS. “As a proactive measure, we will remind our OTP providers of their obligations to comply with state and federal laws and rules for providing and claiming Medicaid reimbursement and ensuring the quality of care for those receiving OTP services.” OA SAS regulates OTPs in the state. For the audit, go to https://oig.hhs.gov/oas/reports/region2/21701021.pdf     

NAMA and AATOD warn Senators not to raise cap

Last week, Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), and Zachary Talbott, president of the National Alliance for Medication Assisted Recovery (NAMA Recovery), wrote a letter to Congress warning against raising the DATA 2000 (buprenorphine prescribing) patient cap from 275 to 500 during the pandemic. The letter to Senators Ed Markey (D‐Mass.), Jeanne Shaheen (D‐N.H.), Maggie Hassan (D‐N.H.), Elizabeth Warren (D‐Mass.) and Dianne Feinstein (D‐Calif.) was in response to an April 17 letter from the senators to Health and Human Services Secretary Alex Azar and Assistant Secretary Elinore McCance‐Katz urging them to increase the cap.     

Briefly Noted

Carmen Beatrice Pearman Arlt died last December after a long illness. News of her death started circulating throughout the field only last month, however. Arlt, a longtime Indiana resident, was born in 1955. She organized one of the oldest chapters of the National Alliance for Medication Assisted Recovery (NAMA Recovery), the Methadone Advocacy Group (MAG) of Indiana. NAMA Recovery Director Joycelyn Woods recalled last week that Arlt, in the early 1990s, sent an index card to NAMA Recovery with dimes taped to it and a short message saying she could not afford the $10 membership fee. “Like all letters we receive from patients, she received a letter back saying that we would rather have her advocacy than money,” said Woods. One of the things MAG of Indiana did was clean the street around the methadone clinic. “While they were out picking up garbage and sweeping the street, the reverend from the church across the street came out to warn them about those addicts over there. Carmen explained that they were those addicts,” said Woods. “From this encounter, patients were given space in the church to set up 12‐Step groups and to have meetings. The following year, there was a big drug conference in Indiana, and the chapter acted as the color guard for the governor when he entered the arena. I remember Carmen sending a picture of them all dressed in white shirts, navy bowties for women and regular ties for men and navy pants.” Arlt received the Nyswander/Dole Award from the American Association for the Treatment of Opioid Dependence in 2001 for organizing the state provider organization — at the time, Indiana had no opioid treatment program representation and clinics saw one another more as competitors than associates working for a common cause, said Woods. More recently, in addition to being president of NAMA Recovery, Arlt developed the program for women and children at Porter‐Starke Services in Valparaiso. She was continuing her education to get a Ph.D. in social work when she became ill. “NAMA Recovery will miss Ms. Pearman‐Arlt's dedication and compassion to patients and the field,” said Woods..     

DEA proposal for mobile methadone finally released

The federal Drug Enforcement Administration (DEA) has issued a long‐awaited proposed rule that would allow opioid treatment programs (OTPs) — treatment programs that use methadone — to transport the medication to patients via “conveyances” (such as vans). This means that patients would no longer have to go to the brick‐and‐mortar OTP.     

Coming Up

The 2018 Best Practices Summit by the National Alliance for Recovery Residences will be held Oct. 8–10 in Indianapolis . For more information, go to http://narronline.org/conference‐2/ .     

Coming Up

The 2018 Best Practices Summit by the National Alliance for Recovery Residences will be held Oct. 8–10 in Indianapolis . For more information, go to http://narronline.org/conference‐2/ .