CareFirst in talks to cover county addiction treatment centers

Anne Arundel County is courting the region's largest health insurance provider, asking it to cover treatment at county-owned treatment centers.

Acting county health officer Fran Phillips said the county is in negotiations with CareFirst to be an addictions treatment provider covered by the insurer, with talks to waive co-pays and deductibles for those in need.

CareFirst spokesman Michael Sullivan said it would mean anyone with an insurance plan that includes a mental health benefit could receive treatment services covered by the insurer at the two methadone and medically assisted treatment clinics in Glen Burnie and Annapolis.

While the insurance company works with a variety of different treatment providers - the company announced in December it would work alongside several clinics to cover "intensive outpatient addiction treatment" for the majority of customers - Sullivan said it's "relatively rare" for a county to be on its network of covered providers.

And the negotiations are a direct outcome of a change in funding from the state last year that resulted in a shift in record-keeping and other operations that have made the clinics run much more like private clinics.

"We have really retrained and stepped up our financial accounting unit," Phillips said. "It's really made the clinics operate in a much more business-like fashion (and) much more efficiently."

The department also is in talks with a number of leaders in the private insurance industry about similar coverage arrangements.

For a region that continues to see record-breaking numbers of opioid overdoses, officials say it's another way to expand access to treatment.

But it also represents a change in confidence in the clinics, as less than a year ago, officials feared they may not have the money to stay open.

Officials wrote in the county's "Local Addiction Authority Plan" for 2018 - which gives a sort of outlook as to the county's ongoing prerogatives in the fight against drug addiction - that a change in state funding put the county's medically assisted treatment program in jeopardy.

In early 2017, the state radically changed the way it funds substance abuse centers, switching from block grants to a reimbursement model where centers bill the state and are reimbursed for services.

While state Department of Health officials say it more closely aligned with how payments were made with private insurers and would give clinics more accurate and direct funding, some worried the state could take too long to reimburse centers for services.

"The move from grant-funded services to fee-for-service ambulatory treatment services directly impacted the Adult Addictions (Medically Assisted Treatment) program," officials wrote in the plan, adding the two clinics in Annapolis and Glen Burnie "provide treatment to more than 800 individuals a year."

"It was determined that closing the clinics in response to the state's request to eliminate direct service delivery was counterproductive to the county's response to the opioid crisis," officials wrote.

Phillips, who was appointed after the change was made, downplayed the original assessment, saying "there was no way that the county was going to consider closing clinics."

Barbara Bazron, executive director of the state's Behavioral Health Administration, said "there was a lot of nervousness about this process initially," but it lessened once counties began working through the growing pains.

Phillips pointed to the responsiveness of the state to reimburse for services, dissuading a major concern for the county.

"I think that the providers have really gained additional efficiencies," Bazron said.

Phillips said previously the county "didn't have to count all services, patients ... what was able to be billed" when it came to the clinics because grant funding was up front.

"If you move to a fee for services system, you don't have it up front," she said.

That led to the clinics being more aggressive in making sure every legitimate billable service was being sent to the state for reimbursement, Phillips said.

In addition, the payback model also "really opened (up) the possibility to offer alternatives to methadone," such as buprenorphine or vivitrol, she said.

But it was those "efficiencies" that made courting private insurance providers more feasible, given the clinics would now have extensive knowledge of how to handle billable services.

The two sides are still negotiating payment rates to the county and Phillips said there's no set date the county is eyeing to get the deal done by.

The county's negotiations could also serve as a catalyst for officials to try to tackle an oftentimes underrepresented portion of the population: the underinsured.

While much has been made of the state's Medicaid-eligible population in need of treatment services, both Phillips and Dave Semanco, clinical director at the Serenity Acres treatment center, have said there is a concern that those with less expensive plans could be caught paying high deductibles if they enter treatment.

"We've got people who are coming in (to treatment) who have punishingly high deductibles," Phillips said.

The county does keep funds available to help those out with those issues, she said, but she added "we want people to be able to come to us ... without the barriers of co-pays and deductibles."

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Credit: By Phil Davis - [email protected]

Caption: Rochelle Fabrizio of Severn demonstrates how she picks up her methadone treatment from Nechele D. at the Anne Arundel County Road to Recovery medication assisted treatment clinic in Glen Burnie.

Joshua McKerrow/Capital Gazette