Pubdate: Thu, 07 Aug 2014
Source: Blade, The (Toledo, OH)
Copyright: 2014 The Blade
Contact:  http://www.toledoblade.com/
Details: http://www.mapinc.org/media/48

EXPANDING TREATMENT

Congress should change an outdated law that is hindering states in 
their battle against addiction

Ohio's heroin and opioid epidemic has finally grabbed the attention 
of Congress. A recently introduced bill would expand treatment by 
changing an outdated law that restricts the use of Medicaid dollars 
to respond to addiction.

The 1965 law bans Medicaid reimbursements to hospitals and other 
medical providers that have more than 16 beds. The provision - called 
the Institution for Mental Diseases (IMD) exclusion - probably made 
sense when Congress created Medicaid. Fifty years ago, the federal 
government aimed to discourage the warehousing of mentally ill patients.

Today most states have a different problem: too few inpatient beds 
for severely mentally ill people. Moreover, the 16-bed cap also 
applies to drug treatment. As such, it has hindered states in their 
battle against the epidemic of addiction to heroin and opioid-based 
prescription painkillers.

The rule has contributed to waiting lists, typically amounting to 
dozens of people, for residential treatment across Ohio. Such delays 
discourage addicts from getting treatment and inevitably lead to more 
fatal drug overdoses, now Ohio's leading cause of accidental death.

The proposed legislation would create a five-year demonstration 
project that would include as many as 10 states. Those states could 
lift the Medicaid bed cap for drug abusers, though the cap would 
still apply to mental-health services.

Treatment providers have been unable to expand their 16-bed inpatient 
treatment centers, despite a growing need for residential care for 
addiction. Such treatment, with all the support it provides for one 
to three months, is especially important to some people in early recovery.

"If they don't have the environment to stabilize, start the recovery 
process, and stay away from outside influences, the risks of relapse 
and overdose go up," James Schultz, director of adult drug and 
alcohol services for the Zepf Center in Toledo, told The Blade's 
editorial page.

The Breaking Addiction Act of 2014 - introduced by two Ohio Democrats 
in the U.S. House, Reps. Marcia Fudge of Warrensville Heights and Tim 
Ryan of Niles - would launch a pilot program that would enable states 
to get federal reimbursement for Medicaid services that treat 
substance abuse at a community treatment center of more than 16 beds.

Expanding Medicaid-eligible services in 10 states is estimated to 
cost $60 million a year. Getting more drug-addicted people into 
recovery and on their way to productive lives, however, should save 
far more in overall government spending, including law enforcement.

The legislation also prudently orders the federal government to 
evaluate and report the results of the pilot program, including its 
effects on costs, access to care, readmissions, and emergency care.

So far, the bill lacks the bipartisan support it needs to clear the 
House. That's more than unfortunate. Partisan politics has no place 
in the fight against addiction. Congress could take a lesson from the 
Ohio General Assembly, which this year has enacted four bipartisan 
laws aimed at the state's opiate epidemic.

Fatal heroin-related overdoses in Ohio have tripled in the past three 
years to more than 1,000 a year. An estimated 200,000 Ohioans are 
addicted to opioids.

Members of Congress should not delay in approving a simple and 
inexpensive change that would help states fight this insidious 
epidemic. That means passing the Breaking Addiction Act now.
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MAP posted-by: Jay Bergstrom