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Bill Would Raise Methadone Clinic Reimbursement Rates

AUGUSTA, Maine — Treatment providers and physicians are among those advocating for an increase in MaineCare reimbursement rates for methadone clinics.

In recent years the rates have been cut as a way to balance the budget. But now that state revenues have stabilized and the public is demanding greater access to treatment, supporters say it’s time to restore the cuts.

Until six years ago, methadone clinics in Maine received $80 a week to provide each patient on MaineCare a bundle of services: medication, individual and group counseling, drug testing and physician assessments. At the time, the clinics had a ratio of 50 patients per counselor.

But in 2010 the rates were cut to $72 a week. And two years later they were reduced again to $60. Since then, clinics have had to double or triple the number of patients per counselor. They’ve also cut back on staff and patients themselves.

“Client volume was decreased from 611 clients in 2010 to 469 in Dec. 2010, and to 442 by Dec. 2012,” says Lisa Harvey McPherson, representing Acadia Hospital in Bangor, a nonprofit provider of outpatient opioid treatment.

McPherson, among those who testified before the Legislature’s Health and Human Services Committee Thursday, supports raising the MaineCare reimbursement rates to pre-2010 levels as a way to strengthen treatment and recovery programs. She says because of the heavy demand for treatment in recent months, the number of clients at Acadia is now up to 500, but there’s a wait list of 80 additional people.

The problem is not unique. Last year a methadone clinic in Sanford closed its doors, saying the low reimbursement rates were a big factor.

“Without funding for medicine, nothing will change,” says state Rep. Linda Sanborn, a retired family physician from Gorham, who quoted Dr. Mary Dowd, an addiction specialist who works at Milestone Foundation’s detox facility in Portland.

Extensive research shows that medications such as methadone and buprenorphine, commonly known as Suboxone, are the most effective treatments for opiate addiction when combined with counseling.

“With methadone or buprenorphine, 80 percent of patients recover, go to work, pay their bills, raise their families,” Sanborn says, again quoting Dowd, on the efficacy of both drugs as backed up by the National Institutes of Health. “Without it, 80 percent relapse even after living years sober. With counseling and rehab alone, 80 percent relapse. With detox alone, 95 percent relapse.”

Sanborn also encouraged members of the committee to reject what she calls a “false argument” that is often used in the debate over methadone and Suboxone, which is that patients are replacing an illegally used opiate for a legally used one.

The National Institutes of Health says that’s not the case. Instead the agency finds that maintenance medication provides “the best opportunity for patients to achieve recovery from opiate addiction.” And Gordon Smith of the Maine Medical Association says because it is the best treatment available, it’s not wise to legislatively or administratively limit clinical decision making.

“And by continuing to reduce the reimbursement for methadone you are taking away that option for some physicians who think this is the best for their patients,” Smith says.

The bill also received support from the Maine Sheriffs Association. There was no opposition.