Virginia rolls out new substance use disorder benefit
March 31, 2017 | By Katie Demeria
Virginia’s Medicaid program is launching a new Addiction and Recovery Treatment Services benefit today meant to provide help for those with substance use disorders across the state.
The benefit — also referred to as ARTS — was prompted by the Governor’s Task Force on Prescription Drug and Heroin Abuse, which submitted 51 recommendations to Gov. Terry McAuliffe in the summer of 2015, including increasing Medicaid rates for addiction treatment.
The ARTS benefit will increase provider rates for substance use intensive outpatient, partial hospitalization, day treatment, case management and medication assisted treatment for opioid addiction.
The rates have not increased since 2007, so few providers actually offered Medicaid patients those services, said Dr. Kate Neuhausen, chief medical officer with the Virginia Department of Medical Assistance Services.
Before, inpatient detox and residential treatment were available only to pregnant Medicaid beneficiaries or those younger than 21, but ARTS will make those available to all Medicaid and FAMIS (Family Access to Medical Insurance Security) beneficiaries.
About 1.1 million people covered by Virginia Medicaid and FAMIS now have access to the ARTS benefit. Most often, addiction treatment is needed for alcohol use disorder, Neuhausen pointed out, but by far the most deadly drugs surging through Virginia are opioids — both in illicit forms, such as heroin, and prescription painkillers.
In the first nine months of 2016, 822 people died from opioid overdoses in Virginia, up from 811 in all of 2015. The complete number of opioid overdose deaths is expected to surpass 1,000 for 2016.
“The opioid crisis can really only be solved by communities working together,” Neuhausen said. “I think the single greatest missing piece has been the evidence-based addiction treatment for the population that already has addiction.”
According to the Centers for Medicare & Medicaid services, Medicaid beneficiaries are prescribed painkillers at twice the rate of non-Medicaid patients and are six times more likely to experience an opioid overdose.
“There are over 200,000 unique Medicaid and FAMIS members who have a substance use diagnosis,” said Karen Kimsey, DMAS’ deputy director for complex care.
“We’re not sure how many people will take advantage of the ARTS program. It will take some time to adjust, and we’re going to be working very closely with stakeholders to help people realize and understand what the benefit is and what is available to them.”
For the past year — since the General Assembly fully funded the ARTS benefit during the 2016 session — DMAS and the Medicaid health plans have worked to educate providers about the new benefit.
“We just looked at our networks yesterday and they look phenomenal,” Neuhausen said during an interview in late March. “We’ve had the vast majority of residential providers in the state sign up with Medicaid.”
Before the ARTS implementation today, DMAS information shows, there were no residential treatment, partial hospitalization, or office-based opioid treatment providers within Medicaid’s network in central Virginia.
With ARTS available, five providers now offer residential treatment, one offers partial hospitalization and now there are four office-based opioid treatment providers, some with multiple locations.
“I would say overall across the commonwealth, providers have done a tremendous job expanding treatment capacity and, especially in metro Richmond, there’s been an extraordinary approach,” Neuhausen said.
The next step is to roll out its peer support services July 1, for those with substance use disorders or mental illness.
“The goal is to have individuals with lived experiences to not only help individuals in crisis, but also support them when they’re more stable and … help them maintain their recovery,” Kimsey said. “It’s easier for individuals to talk to people who have been there. It gives them hope.”