1. Expanding Authority for MAT, New Initiatives and Next Steps Brad DeCamp SOTA Ohio Mental Health & Addiction Services

2. Changes in philosophical approach towards MAT  “Healthy tension” between abstinence only and medication Evolution of medications  Methadone, Buprenorphine, Injectable Naltrexone Changes in reimbursement policies  Medicaid as payer of MAT Changes in service definitions  MAT service rolled into Medical/Somatic Contextual Issues

3. Diversion concerns  Criminal Justice, Law Enforcement Growth in Naloxone distribution  Project DAWN  Regional Psychiatric Hospitals (RPHs) OTP vs. OBOT  Bup only OTP vs. Methadone program  New rules  Pharmacy Board, Medical Board Contextual Issues

4. Growth in methadone programs, client census  9 “Legacy” programs  15 programs  More applications in process  Client Census  July 2011: 4,700  February 2015: 7,000 Ohio OTPs

5.  OTPs now offering buprenorphine and injectable naltrexone (Two bup-only OTPs)  Client Census - Buprenorphine  July 2011: 58  February 2015: 1,200 *  Client Census – Injectable Naltrexone  July 2011: 0  February 2015: 70 Ohio OTPs cont.

6. Enhancing access to Naloxone - $500,000 annually  Legislative efforts to enhance access  Also “Standing Order” concept Addiction Treatment Program  Formerly the Addiction Treatment Pilot Program  Currently active in 6 counties; Certified Drug Courts  Evaluation due later this year from Case Western  $2.5 M per year; looking to expand to additional counties by leveraging Medicaid expansion Executive Budget

7. Partnership with DRC  Leverage OhioMHAS clinical expertise and recovery- oriented mission to build on DRC’s success in keeping recidivism rates low and serve more people within the walls of the state prisons  Augment services within the state prison system to increase treatment resources to levels that meets identified need.  Expand resources for outpatient recovery supports and treatment for released inmates. Executive Budget

8. Background  Statutory Requirements  Non-profit status  Time as certified provider  Methadone rules; treatment services rule  MAT has evolved over time Regulatory Efforts

9. Recent History  Situation in southern Ohio  Enforcement action taken against bup only OTP  Hundreds of patients displaced Interest from other entities  Hospital systems in counties where CDJFS agencies are transporting to methadone clinics Regulatory Efforts

10. TA Request  SAMHSA CSAT Division of Pharmacotherapies  “Rule Review” product  Stakeholder Meeting  State and Federal Regulatory entities – DEA, AG, Pharmacy & Medical Boards  OTPs  Non-OTP MHAS Certified Treatment Providers  ADAMHS Boards  Medicaid Regulatory Efforts

11. Day Rate for buprenorphine?  Similar concept that exists for methadone  Current policy prohibits MHAS programs from billing for maintenance doses  Medicaid is willing to consider approach Centralized Database/HIE Regulatory Efforts

12. As we begin this process… We have a set of rules of codes that are outdated, do not regulate OTPs evenly and do not account for the advances in MAT to treat opioid dependence Current State

13. At the end of the day, we want… More modernized set of rules and statutes to govern MAT in the public MHAS system that increases patient access to quality services while maintaining safeguards that prevent diversion Future State

14. Not location, location, location…  Diversion, diversion, diversion  Legitimate concern  Harder sell with CJ and LE  Good providers are having to adjust their practice to account for all of the changes that were implemented to remove bad actors Themes (not Memes)

15. Large group practices of DATA 2000 physicians  How will they be regulated?  Are they operating in the spirit of DATA 2000?  “Suboxone Hubs”  Cash only, multiple physicians Themes (not Memes)

16. On the horizon…

17. Managed Care  Not carve out, carve in  What does the BH system need to make this happen? Continuum of Care What does the BH system need to make this happen? On the horizon…

18. Bradley M. DeCamp, MPA Chief, Behavioral Health Policy and Program Implementation/ State Opioid Treatment Authority Ohio Mental Health & Addiction Services 30 East Broad St., 36th Floor Columbus, Ohio 43215 bradley.decamp@mha.ohio.gov (614) 752-8363 Contact information