John O’Brien, who directs the Technical Assistance Collaborative‘s (TAC) work on substance use disorders writes, “The Trump administration’s interest in addressing the opioid epidemic is heartening, and last week’s proclamation is a welcome acknowledgment that opioid addiction and overdoses do indeed constitute a major public health crisis in our nation.”
The numbers around New Jersey’s opioid crisis are staggering. NJ Advance Media estimated that opioids resulted in over 2,000 deaths in 2016.
O’Brien point out that in fact, billions of dollars are needed to end opioid addiction in the United States. “… There has at least been the promise of statutory and regulatory relief – with a particular focus on allowing states to waive the Institutions for Mental Diseases (IMD) exclusion. This 52-year-old statute bars Medicaid payments for mental health and addiction treatment provided to individuals in large treatment facilities, and some advocates assert that waiving it will allow Medicaid funds to flow for thousands of substance use disorder (SUD) treatment beds that currently lie empty.”
O’Brien writes about the importance of expanding access to opioid addiction treatment.
“All efforts to expand access to treatment are important, but the push to open up large facilities for SUD care as the first priority should be kept in perspective.”
Communities may see empty treatment beds if community-based treatment options provide an alternative to treatment facilities.
Additionally, “In some cases, beds go unused if private payers don’t refer patients to a facility because it lacks a modern, evidence-based approach to treating addiction (for instance, if no-one on staff is qualified to provide medication-assisted treatment). And finally, some facilities have never participated in either Medicaid or commercial insurance programs simply because they don’t have to, as their private fee structure allows them to maintain empty beds; these providers may have neither the financial motivation nor the business operations know-how to bill insurers, or to train their staff to meet the quality standards of states and commercial payers.”
So, states – before you rush off to the Centers for Medicare and Medicaid Services asking for IMD waivers, make sure your request is going to make a true difference in getting people high-O’Brien cautions states to make sure that any IMD waiver and funding that they request, is truly want the need to address the opioid crisis in their state. Concludes O’Brien “We won’t turn this crisis around by assuming that any treatment is better than no treatment.”
In September 2017, New Jersey Governor Chris Christie defended the added expense of eliminating the Institutes for Mental Disease Exclusion saying:
“The deaths in 2016 (nationally) are going to be about 64,000,” Christie said. “Every three weeks we have a 9/11 due to drug overdoses in this country. Are you really willing to put up with that level of death, to have 17 9/11s a year? I’m not.”