Microsoft word - methadone testimony.doc

Legislative Budget and Finance Committee
A Performance Audit of Pennsylvania’s Medical Assistance
Transportation Program for Methadone Maintenance
Report Presentation by Patricia Berger, at February 9, 2011, Meeting
Good morning. Senate Resolution 2010-348 directed the Legislative Budget and Finance Committee (LB&FC) to conduct a performance audit of Pennsylvania’s Medical Assistance Transportation Program for methadone maintenance treatment. Further, SR 348 specifically asked us to determine the annual medical assistance (MA) costs to the Commonwealth for methadone treatment and the length of time in treatment for persons receiving methadone maintenance treatment. Methadone is the most frequently used medication for treating addiction to opiates such as heroin and morphine. Methadone treats this addiction by acting on the same targets in the brain as opiates and blocks the effects of the drug, sup- presses withdrawal symptoms, and relieves cravings for the drug. It does not cause euphoria, intoxication, or sedation. Methadone is used for detoxification and also In addition to methadone, there are several other treatment options available for opiate addiction. These include: detoxification either with or without medica- tion; buprenorphine; naltrexone; suboxone, which is a combination of buprenorphine and naltrexone; and drug-free treatment, which focuses on behavior modification. Methadone maintenance treatment is provided at Narcotic Treatment Pro- grams, which are licensed and approved by the Department of Health (DOH). As of June 2010, 58 NTPs operated in Pennsylvania in 28 counties primarily in the east- ern and western areas of the state. Generally, clients receive daily doses of metha- done at the NTPs. We found that for CY 2009, medical assistance treatment costs, excluding transportation, were $48.8 million for 18,884 methadone clients, which is Under Pennsylvania’s State Medicaid Plan, the Commonwealth must ensure that clients have transportation to and from their health care providers. As such, Pennsylvania uses its Medical Assistance Transportation Program (MATP) to pro- vide non-emergency transportation services to clients who need transportation. These services include mass transit; paratransit, which includes taxis; and the use of a personal vehicle in the form of mileage reimbursement. County MATP offices are responsible for ensuring that clients are eligible for transportation services and that the least costly, most appropriate method of transportation is used. To ensure that only those eligible for and needing transportation receive it, NTPs verify clients’ attendance at the clinic. Several NTPs responding to our ques- tionnaire described procedures they use to ensure that clients are only reimbursed for appropriate transportation services. This includes using a special stamp or des- ignated personnel to sign transportation forms, requiring clients to present their bus pass for inspection, and turning the previous pass in before receiving a new pass. These procedures, however, are voluntary. We recommend that DPW develop a “best practices” guideline for providers to use to ensure the appropriateness of In FY 2009-10, expenditures for transportation costs for methadone mainten- ance clients were $32.5 million, which is about 22 percent of total MATP costs. To- tal MATP costs, $131 million in FY 2009-10, were about 1 percent of the total MA budget. Over the last three fiscal years, methadone maintenance transportation was about 38 percent of all MATP trips, likely due to the daily nature of the treat- In an effort to reduce costs, DPW recently changed its policy for methadone clients who claim mileage reimbursement. Beginning in October 2010, mileage reimbursement was restricted to one of the two closest clinics to the client’s resi- dence, with a maximum reimbursement of 50 miles one way. Prior to this policy change, clients could be reimbursed for transportation to any NTP statewide within a Behavioral Health-Managed Care Organization’s network of providers, a policy that was criticized in several media reports. Exceptions to the new policy are made when, for example, the closest clinic is more than 50 miles away or if a facility is not accepting new clients. DPW calculated a cost savings of $1.3 million by restricting reimbursement to the second closest clinic. An additional $500,000 in savings could be achieved if clients were restricted to the closest clinic, but DPW thought that too In January 2011, a similar restriction was implemented for methadone main- tenance treatment paratransit services. Current clients, however, were grandfa- thered in and allowed to continue to receive paratransit services to their current provider. DPW calculated a cost savings of $560,000 by restricting reimbursement to the second closest clinic. An additional savings of approximately $840,000 could have been achieved if reimbursement was restricted to the closest clinic, but, again, DPW thought clients should have some degree of choice. Between the two types of transportation, the new policies result in a total savings of $1.8 million. This sav- ings would total $3.2 million if transportation services were restricted to the closest The report also contains information on the average length of time in metha- done maintenance treatment, which is a little over two years, and information on some alternatives to methadone for treating opiate addictions. In closing, we wish to acknowledge and thank the Departments of Public Welfare and Health for the cooperation and assistance their staff provided during this study. We would also like to thank the providers who responded to our survey as well as the stakeholders

Source: http://lbfc.legis.state.pa.us/reports/2011/38prs.PDF