Federal Regulation of Methadone Treatment (1995) / Chapter Skim
Currently Skimming:
Methadone Treatment
Methadone Treatment
Pages 151-184
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 151... ...
These limits are discussed below as appropriate. THE PROVIDER COMMUNITY This section describes the characteristics of providers of outpatient methadone maintenance programs the number of treatment facilities, the regional distribution of facilities, the number of patients, and the capacity, utilization, waiting time, and ownership.
|
From page 152... ...
survey of methadone facilities called the National Drug and Alcoholism Treatment Unit Survey (NDATUS) , data are reported by drug abuse and alcoholism treatment providers to their respective state agencies, which forward it to SAMHSA.
|
From page 153... ...
On a per capita basis, the Northeast has the highest rate of methadone patients at 94 per 100,000 population, followed by the West at 46, the Midwest at 22, and the South at 19 (see Table 6-1~. TABLE 6-1 Regional Distribution of Methadone Patients, 1992 1992 Number of Percentage of Resident Region Patients Total Patients Populationa Patients per 1,000 Populationb West 25,124 24.3 55,108,000 0.46 Midwest 13,453 13 60,713,000 0.22 Northeast 48,230 46.6 51,118,000 0.94 South 16,687 16.1 88,143,000 0.19 Total 103,494 100 255,082,000 0.41 aBureau of the Census, 1993.
|
From page 154... ...
Melnick, SAMHSA, unpublished data, 19941. Number of Patients In 1993, the most recent year for which national estimates of methadone patients were available, an estimated 117,000 patients received methadone treatment (Harwood et al., 1994~.
|
From page 155... ...
SOURCE: NDATUS, Office of Applied Studies, SAMHSA. NDATUS provides the only national data about methadone treatment capacity and utilization, important indicators of the availability of treatment.
|
From page 156... ...
Although a useful indicator, NDATUS's capacity utilization rate is not adjusted for differences in unit size. A special analysis of NDATUS's 1991 survey conducted by Lewin-VHI, Inc., yielded a weighted average utilization rate of 91.5 percent (based on 521 methadone treatment units that reported on both patients and capacity)
|
From page 157... ...
157 In California, the utilization rate varies according to whether the slot is reserved for private patients (who have private insurance or pay out-of-pocket) or for subsidized patients (those who receive mostly county, state, federal block grant, or Medicaid funding)
|
From page 158... ...
Waiting Lists Although waiting times for admission to treatment programs led to the inclusion in the ADAMHA Reorganization Act of 1992 of a provision authorizing interim methadone maintenance treatment as a way to increase access to treatment, especially for intravenous drug users at risk of contracting AIDS (see discussion in chapter 5) , the national data on waiting lists are not very good.7 Several national surveys on waiting lists suggest strong regional differences.8 In New York City, for example, some facilities do have long waiting lists, which implies administrative or state regulatory limits on slots or program responses to limited financing.
|
From page 159... ...
The National Drug Abuse Treatment System Survey asked clinic directors to estimate the average waiting time for a client seeking admission to their clinic. Thirty-eight percent of clinics reported no waiting time; less than 7 days' average wait was estimated for 10 percent of the clinics; 7-14 days' average wait was estimated for 19 percent; and 15-95 days for 33 percent (T.
|
From page 160... ...
However, New York State regards waiting lists as only one indication of demand for treatment. California's monthly Drug Abuse Treatment Access Report, in March 1993, listed 2,488 applicants waiting for one ofthe 13,154 licensed methadone maintenance treatment slots (S.
|
From page 161... ...
On the national level, NDATUS collects expenditure data on methadone treatment that are separate from overall alcohol and drug treatment data. Although available on data tapes, these data are not otherwise easily accessible to the public.
|
From page 162... ...
, which accounts for 80 percent of all financing, includes three components state agency funding, federal block grants, and Medicaid, all of which are administered by state agencies. Financing from all sources of all state alcohol and drug abuse programs that receive some state funding is surveyed annually in the State Alcohol and Drug Abuse Profile (SADAP)
|
From page 163... ...
. TABLE 6-6 Trends in Financing of State-Supported Alcohol and Other Drug Abuse Services by Largest Funding Sources Federal Block State Alcohol/ Year Grant Drug Agency Private Insur- Medicaid and ance Client Other Public Feesa Sourcesb 1987 15% 45% 22% 9% 1988 17% 43% 20% 11% 1989 20% 42% 18% 12% 1990 22.2% 37.8% 15.7% 16.6% 1991 29.2% 34.7% 15.5% 13.7% 1992 30.2% 32.8% 18.1% 12.3% NOTE: Data are from the State Alcohol and Drug Abuse Profile (SADAP)
|
From page 164... ...
Table 6-6 shows that in 1992 block grants accounted for 30.2 percent of all substance abuse funding, up Tom 1987, when it accounted for 15 percent of the total. Between 1987 and 1991, state agencies reported an increase in block grant revenues from about $273 million to nearly $1 billion (Table 6-7~.~° Since the establishment '°Alcohol Drug Abuse and Mental Health (ADM)
|
From page 165... ...
Medicaid-certified methadone facilities received about 30 percent of their revenues from Medicaid, a percentage greater than nonmethadone treatment facilities that were also Medicaid-certif~ed (Horgan et al., 1 994~. Department of Veterans Affairs The Department of Veterans Affairs (VA)
|
From page 166... ...
Although much is known about the characteristics and costs of the inpatient substance abuse population, the VA did not collect data until recently about the number of outpatient substance abuse patients, including methadone patients, and their cost of care. In 1993, the first year for which data were available, a total of 5,886 patients nationwide received methadone maintenance treatment at approximately 36 VAMCs (R.
|
From page 167... ...
The DSRS survey found that 4.4 percent of methadone patients at all facilities were expected at admission to be covered by private health insurance and an additional 1.9 percent by an HMO or other prepaid plan (Table 6-8~. In comparison to patients receiving other types of drug treatment, methadone patients were the least likely to have private health insurance coverage.
|
From page 168... ...
(292 pts.) Public subsidy 2.6% 0.0% 7.1% 4.2% Philanthropy 0.0% 0.0% 0.0% 0.0% No payment, un- 0.0% 0.0% 0.4% 0.2% specified Self-pay 11.5% 77.2% 25.5% 30.8% HMO/other pre- 0.0% paid plan Private health 1.3% Insurance 3.6% 2.6% 1.9% 0.0% 8.3% 4.4% Medicaid 29.1% 15.6% 30.2% 27.0% Medicare Other federal (DOD, Champus, VA)
|
From page 169... ...
Most of the estimated $480 million In total treatment expenditures comes Tom public sources, such as state substance abuse agencies, federal block grants, and Medicaid. Private out-of-pocket payments account for an estimated 17 percent of the total, and private insurance accounts for the smallest portion, only 2.5 percent of the total (Lewin-VHI, unpublished estimates, 19941.
|
From page 170... ...
Fenton, New York State Office of Alcoholism and Substance Abuse Services, unpublished data, 1994.) The average clinic census is 269 patients; in New York City, five clinics have a license capacity greater than 550.
|
From page 172... ...
Medicaid accounts for 62.4 percent of this total, far higher than the national average of 12 percent, followed by the federal block grant at 15 percent and the OASAS state aid at 14.6 percent. Patient fees accounted for an estimated 2.6 percent of treatment costs.
|
From page 173... ...
The pilot program helps disabled patients receiving Home Relief to qualify for SSI and thereby become eligible for federal Medicaid. All voluntary, not-for-profit clinics qualify for state agency funds, for whom the state is the "payer of last resort." Once Medicaid, client fees, and private insurance have been obtained, the remaining costs at these publicly funded clinics are covered by state Office of Alcoholism and Substance Abuse Services funds and federal block grant funds so they do not operate at a deficit.
|
From page 174... ...
In 1994, about 20,000 methadone maintenance patients were treated at any one time, including those in temporary treatment slots authorized by the state to respond to the AIDS epidemic. The number of patients receiving methadone grew substantially between 1987 and 1992, increasing by 52 percent (see Table 6-9~.
|
From page 175... ...
Public funding for drug treatment in California has traditionally come from state general funds, federal block grants, and Drug MediCal. The former two sources of funds are combined into a funding stream known as Drug Allocation Money, which is allocated among California counties according to a complex formula and requires a 10 percent match from county revenues.
|
From page 176... ...
In l 994,Drug MediCal policies were undergoing change owing to a lawsuit in which the court ruled that persons who qualify for MediCal are entitled to receive methadone maintenance if they otherwise meet eligibility requirements for admission, and a certified program had available capacity. While the details of this new financing system are still being worked out, currently state general funds are being made available to the counties to pay for the treatment of MediCal recipients, including those who qualify for methadone treatment; any funds left over can be used to fund treatment slots for other people in need of treatment who are not MediCal eligible.
|
From page 177... ...
(Temporary slots licensed by the state are not the same as slots for "interim methadone maintenance," which were authorized under the ADAMHA Reorganization Act of 1992 in FDA regulations of January 1993.) California's regulations are more stringent than federal regulations regarding take-home policies.
|
From page 178... ...
Some private, for-profit clinics accept only client fees as payment for services; they do not accept private insurance or Medicaid, and they are ineligible to receive state agency and block grant funding. The average annual cost of treatment in Florida in private, not-for-profit units ranges from about $2,600 to 3,200.
|
From page 179... ...
All licensing, monitoring, and program coordination are orchestrated by the Illinois Department of Alcoholism and Substance Abuse. Fnanclng The 29 private, not-for-profit clinics received $10.7 million from state agency and block grant funds and $6.03 million from Medicaid in fiscal 1993, but state administrators had no information on client fees and private insurance.
|
From page 180... ...
The Bureau of Substance Abuse Services contributes $5 million or 3 8.5 percent of the total, of which 75 percent comes from legislative appropriations and 25 percent from federal block grant funds. Client fees account for $0.8 million or 6 percent of the total, and private insurance for
|
From page 181... ...
The effects of federal block grant funding of substance abuse treatment on reducing the availability of data about methadone treatment, for example, as well as the effects of a governmentwide reduction in data collection in the
|
From page 182... ...
1993e. Substance abuse prevention and treatment block grants.
|
From page 183... ...
Medicaid Funding for Drug Abuse Treatment: A National Perspective. NIDA Treatment Services Research Monograph, Rockville, Md.
|
From page 184... ...
1992. ~ Fifty-State Survey of Medicaid Coverage of Substance Abuse Services.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.