August 20, 2018
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An addiction policy that will only hurt Maine people

Christopher Cousins | BDN
Christopher Cousins | BDN
U.S. Health and Human Services Secretary Tom Price, left, and Kellyanne Conway, a senior adviser to President Donald Trump, visited the State House for a round-table listening session on the state and nation's opioid addiction crisis, May 10, 2017.

At a time when Maine government should be making it easier for people to get help for their substance use disorder, it did the opposite.

The LePage administration made it more difficult for people to get naloxone to reverse opioid overdoses.

It has prevented Medicaid expansion, even when voters successfully fought for it at the polls and a judge ruled that the administration must move forward.

It has restricted Suboxone and methadone treatment by putting time limits on their use, even though no science backs that decision.

The administration’s latest move was to inform addiction treatment agencies across Maine in May that it was changing the way in which they got paid to provide residential care, detoxification services and counseling programs, starting July 1.

Instead of signing annual contracts with the Maine Department of Health and Human Services to provide services, largely to the uninsured, the agencies would have to bill for each individual service they perform.

Switching to a fee-for-service model would effectively reduce their funding, they said, because not all their work fits neatly into a billable service under MaineCare, the state’s Medicaid program. And doing so with just two months notice gave them little time to figure out how to overhaul their budgets. The department didn’t provide guidance on how to do so and didn’t ask for input from providers.

What’s more, Maine is still in the middle of an opioid epidemic.

Eighty-six people died from drug overdoses in the first quarter of 2018, about on par with the 89 who died in the first quarter of 2017, according to information released June 1 by the Maine attorney general’s office.

So it was welcome news when DHHS listened to providers’ concerns and said it would delay the rollout of the new payment model to Jan. 1, 2019.

The extra six months will at least give the agencies time to figure out whether and how they will make changes to accommodate the new funding structure.

But it’s still the wrong move to force these organizations to absorb what they say will be cuts in revenue. The change, even with the delay, could do lasting harm.

Here’s one example.

At Wellspring, based in Bangor, the organization’s new detox center would have closed if the payment model change had taken effect in July. That’s because New Horizon in Hampden opened in January and is understandably not yet full. If it only got reimbursed when it had patients in a bed, it wouldn’t bring in enough money to stay open and become established.

But even if the center reaches 90-percent capacity in the next six months, it still won’t be enough. Wellspring is going to fight for it: It will look for private funds to fill the gap.

And while their effort should be lauded, there is no reason it should have to go to these lengths to provide care to people who could otherwise die. Withdrawing abruptly from alcohol can be deadly.

Instead of making it more difficult for organizations to help those with substance use disorders, the state should be increasing funding and opening up opportunities for people to get help. We encourage the department to not just delay the payment model change but rethink it entirely. It’s already done enough damage.

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