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Medicaid Coverage for Methadone in Illinois: AATOD Medicaid Webinar

This webinar discusses the history and implementation process of Medicaid coverage for methadone treatment in Illinois. It covers the need for expanded medication-assisted treatment, legislative actions taken, and the current status of implementation.

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Medicaid Coverage for Methadone in Illinois: AATOD Medicaid Webinar

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  1. Medicaid Coverage for MethadoneIn Illinois:AATOD Medicaid WebinarRichard WeisskopfState Opiate Treatment AuthorityIllinois Department of Human Services Division of Alcoholism and Substance AbuseIDHS/DASAMarch 29, 2017

  2. ILLINOIS TREATMENT SYSTEM • 73 Methadone programs serving 11,700 patients • Funding approximately $22 M • 515 Physicians approved to prescribe Buprenorphine

  3. HISTORY • Medicaid coverage for Methadone in Illinois ended in the mid-90s • Overall Medicaid reimbursement in Illinois was spiraling especially in Detox and Residential programming • Although Methadone programs were not abusers and reimbursement was comparatively small, it was cut as a high-visibility item with little support and residual stigma • Medicaid did continue to reimburse for counseling services

  4. HISTORY • With demand for Medication Assisted Treatment outweighing system capacity, periodic talks began with Department of Healthcare and Family Services (IDHFS) where Medicaid lives • There was little progress • With the onset of the Heroin/Opiate Crisis, the need became even greater

  5. History • Talks were renewed with some positive progress before the 2014 elections • With the election and a change in administrations, talks were renewed • Unfortunately, because of the change of players, talks had to begin from square one • Progress was slow with IDHFS having to be educated in MAT

  6. HISTORY • With the onset of the National Heroin/Opiate Crisis heavily impacting Illinois, the need for a substantial state response and Medicaid coverage for MAT became a priority • Legislative Hearings were held statewide in 2014-15 with testimony from parents, educators, healthcare workers, coroners, treatment providers, lawyers, judges, law enforcement, EMTs and other First Responders • The result was Illinois Heroin Crisis Act (HB -0001)

  7. HOUSE BILL-001 HB-001 is an extensive response to the Heroin Crisis: - Expansion of Medication Assisted Treatment - Providing Medicaid Coverage to Methadone Treatment - Elimination of the existing prior approval and time limits for Suboxone Treatment - Provisions for the expansion of Drug Overdose Prevention Programs, availability of Naloxone through pharmacies, and training for Pharmacists - Safe Prescribing Practices Training for Physicians and other medical professionals and more

  8. PA99-0488 (HB-001) • While the bill passed into law, implementation has yet to take place • Numerous discussions between IDHS/DASA and IDHFS took place following passage of the bill which allowed IDHFS to approve Medicaid reimbursement for Methadone and include it on its State Plan as required • This approval has been sent to the federal government, which must also approve this addition • Federal approval is expected but is still pending

  9. IMPLEMENTATION • Once approved by the federal government, there are still issues to be resolved • Matching Funds: Illinois has not had a budget for almost two years • Procedures: Must be finalized for providers to bill for the newly-approved Methadone services • Rates: Bundled? Individual services? Bundled with additions?

  10. FOR ADDITIONAL QUESTIONS Richard Weisskopf Division of Alcoholism and Substance Abuse State Opiate Treatment Authority 401 S. Clinton ST, 2nd Floor Chicago, IL 60607 312/814-3840 richard.weisskopf@illinois.gov

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