1. MAT Funding Approaches Linda J. Frazier, RN, CHES, MA Treatment Manager Maine Office of Substance Abuse, DHHS

2. Maine SSA Context 9 OTP Clinics serving 4,710 clients receiving Methadone SOTA – State Opiate Treatment Authority History of using Medicaid Funding for treatment; State Plan includes and supports key components SSA seen as authority on Treatment Issues; Solid Relationships across and within state systems and the provider community

3. System Change – Ensure Reimbursement for MAT Legislature approved budget request for $600,000 over biennium to purchase medication, Continued support of Medicaid for MAT, $100,000 in SFY 08 will be used to increase funds to four pilot agencies and add at least two other pilots This is probably not enough money so we will have to figure out how to further meet the demand Develop plan for SFY 09 use of $500,000 – explore whether using the state buying power is a better distribution method

4. Partnership With MAT Agency Pilot Sites Four original AR MAT pilots and 2 added vivitrol sites. OSA sponsored training to address staff education and identified barriers of prejudice and ignorance about MAT. OSA contract specifies that all LOC will not have policies that discriminate against clients prescribed MAT. Develop treatment processes & protocols – ID need for medication, patients right to have MAT, address internal barriers like staff attitudes.

5. Challenges Addiction is a Chronic Health Condition! Getting and keeping money in MAT contracts Preventing Prior Authorization for Medications for Addiction Treatment Defending MAT budget allocations amidst state and department wide fiscal cuts Using data results to support the above and make the business case for sustaining and expanding access to MAT

6. Suboxone/Subutex Clients as % of MaineCare Total Total ClientSuboxone Clients% Suboxone 2000 153,157 2001 167,076 2002 185,22510.0% 2003 215,5493560.2% 2004 225,0248100.4% 2005 231,1031,1420.5% 2006 231,4751,7990.8% 2007 200,0912,0321.0%

7. Suboxone/Subutex Expenditures 2002-2007(YTD)

9. Percent of non-methadone admissions with MAT other than methadone

10. Percent of admissions with Buprenorphine

11. Reduced use at discharge: AR agencies

12. Reading Resources Drug Dependence, A Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation by A. Thomas McLellan et al. JAMA, October 4, 2000, Volume 284, No. 13. Health Behavior Change: A guide for Practitioners by Stephen Rollnick, Pip Mason, and Chris Butler, Churchill Livingstone, 1999. Motivational Interviewing: Preparing People for Change, 2 nd Edition by William R. Miller and Stephen Rollnick, Guilford Press, 2002. Addiction and Change: How Addictions Develop and Addicted People Recover by Carlo C. DiClemente, Guilford Press, 2003.