1. Trends In Substance Abuse And Substance Abuse Treatment

2.  Taft-Hartley Trust Fund established in 1962  Nineteen NY/NJ Teamster Unions participate  Serves approximately 28,000 families  Services provided include:  Employee Assistance Program  Admission precertification and case management  PPO of directly contracted treatment facilities

3. P RESENTATION T OPICS  How We Got To Where We Are Now  Prescription Drug Abuse  The Heroin Epidemic  Other Popular Drugs Of Abuse  Emerging Trends In Substance Abuse Treatment  Protecting Your Benefit Plans

4. How We Got To Where We Are Now

6. Affordable Care Act  No lifetime or annual limits.  Mandated coverage for 19-25 year olds  Financial requirements for mental health and substance use had to be equivalent to other health services.  Quantitative treatment limitations for mental health and substance use had to be equal to other health services.  Utilization management techniques had to be formulated in a manner similar to that for mental health and substance use and other services. MHPAEA

7. Complying with Mental Health Parity does not mean no limitations. It means limitations on behavioral health simply cannot be more restrictive. Important MHPAEA Details

8. Prescription Drug Abuse

11. NY Times Report January ‘16  “Drug overdoses are driving up the death rate of young white adults in the United States to levels not seen since the end of the AIDS epidemic more than two decades ago”  “The rising death rates for those young white adults, ages 25 to 34, make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it.”

13. The Heroin Epidemic

14. Heroin by the Numbers 39% Rise In Heroin-related Deaths Source: NY Times The Numbers Behind America’s Heroin Epidemic

15. Heroin by the Numbers 90% Of first-time heroin users are white Source: NY Times The Numbers Behind America’s Heroin Epidemic

16. Heroin by the Numbers 75% Of Heroin Addicts Used Prescription Opioids Before Turning to Heroin Source: NY Times The Numbers Behind America’s Heroin Epidemic

17. Heroin by the Numbers 325 Opioid-Related Deaths in New Hampshire in 2014 Source: NY Times The Numbers Behind America’s Heroin Epidemic

18. Heroin by the Numbers 50% Increase in Mexico’s Opium Production in 2014 Source: NY Times The Numbers Behind America’s Heroin Epidemic

19. Global Heroin Trafficking Routes

20. Other Popular Drugs of Abuse

21. Synthetics  Synthetic cannabinoids  Synthetic stimulants  Synthetic cathinones

22. Flakka A dangerous synthetic cathinone drug called alpha-pyrrolidinopentiophenone (alpha-PVP) Flakka crystals can be eaten, snorted, injected, or vaporized Like other drugs of this type, alpha-PVP can cause a condition called excited delirium that involves hyper-stimulation, paranoia, and hallucinations that can lead to violent aggression and self-injury. Flakka has been linked to both heart attacks and suicides. It can also dangerously raise body temperature and lead to kidney damage or kidney failure.

23. Xanax Generic: Alprazolam Drug Class: Benzodiazepine Uses: Manage symptoms of anxiety disorders Abuse: Frequently taken in combination with other drugs After a prolonged period of use, can cause changes to the receptors in the brain. Eventually an individual builds up a tolerance to these medications and requires more and more dosages in order to produce the initial effects.

24. Emerging Trends In Substance Abuse Treatment

25. Traditional Treatment Center Model ADMISSIONS BILLING UTILIZATION REVIEW

26. Emerging Treatment Center Model ADMISSIONS BILLING UTILIZATION REVIEW

27. The Rise of Intensive Outpatient Programs IOP Basics  HCPCS Code: H0015  Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week Why This Model?  Often avoids precertification and utilization review requirements  Offers many financial advantages over inpatient treatment  Fewer credentialed/licensed staff  Allows for frequent drug testing

28. Deceptive Treatment Program Tricks  Deceptive websites  Hijacking Internet searches  Providing services outside of their state licensure role  “Last covered day” games  Treatment add-ons billed separately

29. HIGHLIGHTS FROM AN EMAIL BEING SENT TO TREATMENT FACILITY ADMINISTRATORS Currently we are assuming the following amount of remuneration that can be realized per specimen; Toxicology $330, Blood Testing $100 A small account has revenue of $90,000 a month, we can run a proforma for your set of conditions. National companies like Elements, AAC, who are well funded, have opened or are in the process of building their own diagnostic lab for additional efficiencies. It is exclusive to you, whether you have 10 Tox screens a month or 1000 doesn’t matter. Monthly dividends are dependent on collections and reimbursements only. I can promise you that this opportunity can ……give you a tremendous infusion of unrealized revenue in a compliant, accountable and transparent way, unprecedented in the industry.

30. Common Drug Testing Scams  Testing urine on site, then routinely sending the sample for more sophisticated tests at other labs, even if the original urine sample showed no sign of drugs  Testing for multiple drugs the client has never used or shown any interest in using  Testing daily or every other day  Frequent testing even after the client has remained sober for months

31. How Urine Becomes Gold  1 addict X  3 tests a week at $3,000 each  = $36,000 a month  = $432,000 a year  House six addicts  Rake in $2.5 million annually

32. Protecting Your Benefit Plans

33. E STABLISH A G ATEKEEPER  Require prior authorization for substance abuse treatment at multiple levels of care  Authorization should come from a high touch agency that is both Fund focused AND treatment savvy  Insist on direct contact with the identified patient  Assess to determine level of care  Make patient aware of potential out-of pocket costs

34. R EASSESS ALL MEDICAL BENEFITS  Funds are beginning to limit inpatient stay coverage  120, 90, 60, 45 day limits  Consider requiring prior authorization for non-inpatient levels of care  Ex. Partial Hospitalization, Intensive Outpatient  Consider setting dollar caps and utilization maximums on out-of-network drug testing  Review prescription utilization, especially use of opiate-based medication and benzodiazepines  Consider hiring third party firm to perform medication monitoring for commonly abused prescriptions

35. D EVELOP YOUR OWN TREATMENT NETWORK  Direct contract with at least 3 different inpatient facilities.  Programs need to be state licensed and should be JCAHO accredited.  Insist on all-inclusive per diem rates.  Talk to your peers to find out what facilities they use.  Important – Treatment quality should be your primary concern.

36. C OMMUNICATE, C OMMUNICATE, C OMMUNICATE T HREE K EYS TO S UCCESSFUL P LAN R EDESIGN : C OMMUNICATE, C OMMUNICATE, C OMMUNICATE  Repeatedly make your plan participants aware of any and all changes to the plan rules, policies and procedures.  Even if you decide to not make any changes to the plan at this time, at a minimum, you should inform your participants of the dangers of attending treatment at out-of-network treatment programs.