Monday, December 15, 2014

60 Minutes: Insurance Co.'s --A Formidable Barrier to Care

DHMH Should Consider Reviewing All Insurance Denials for Long-Term SUD Treatment

60 Minutes investigates how insurance companies review claims for long-term residential treatment for mental health disorders.  Connecticut's Sandy Hook Commission calls the insurance review process "a formidable barrier to care", and recommends that "a state agency review all denials".  

Thursday, December 11, 2014

Heroin Action Coalition Legislative / Policy Agenda: 2015
For more information contact: or call 301-525-6183

1)  Awareness Campaign:  Even though advocates worked hard to pass two landmark pieces of legislation: 1) the Overdose Prevention Bill, allowing family members to obtain Naloxone (a drug that reverses overdose); and 2) the Good Samaritan Bill, which allows witnesses of an overdose to call for help without the fear of criminal prosecution, attempts to educate the public on these initiatives that save lives has been sorely lacking.  We need a public awareness campaign to end the stigma surrounding addiction and provide families and friends with these life-saving tools.  

2)  Treatment Capacity:  The state's treatment capacity does not come close to addressing the need --particularly in the area of adolescent and transition-age residential treatment and recovery services.  While advocates support medically assisted treatment (MAT) for those who want it, it should not be considered a substitute for long term residential treatment options which promote abstinence.  Maryland must find a way to maintain a full continuum of treatment options, rather than just those that are the least costly or most profitable.  Funding that was cut from the treatment budget in past years must be restored. 

3) Funding:  In order to close the treatment capacity / need gap, the state must be willing to look at creative funding options and to create public-private partnerships.  Opportunities for funding, similar to the legislation that diverted certain criminal fines to a Crime Victim’s Assistance Program, must be explored.  Similarly, fines from drug-related crimes could be diverted to treatment.

4)  Performance Measures:  Regarding the treatment we do have, there are absolutely no standardized performance measures, and oversight and accountability for treatment providers is nearly non-existent.  This means that our tax dollars are paying for programs, and tax payers have no idea whether they are succeeding at doing the job that they are being paid to do.

5)  Uniform Assessment Criteria:  Maryland has no uniform criteria for assessing the level of treatment an individual needs –even though DHMH claims to use ASAM criteria.  In reality, each individual treatment provider is able to operate under their own criteria, which is often based on the varied and random criteria of various insurance providers.  These multiple and inconsistent standards leave patients and family members caught in the middle --often forced to pay thousands of dollars in out-of-pocket expenses, due to the state's failure to mandate that a unified set of criteria be used throughout the state –by both those providing treatment and those paying for it.  

6)  Integrated Regulations:  Despite huge amounts of tax dollars spent on behavioral health integration over the last four years, there has been absolutely no effort to actually integrate treatment practices and systems --as evidenced by the lack of an integrated set of regulations governing mental health and SUD treatment providers. The discrepancies that exist between basic standards for mental health treatment (with 30 regulations) and SUD treatment (with 8 regulations) are so vast that it causes consumers to wonder what if anything, has actually been integrated.  We must have integrated treatment for co-occurring disorders, and this must be reflected in our Maryland regulations. 

7)  Oversight:  Currently, state leadership is weak. There is little direction or oversight for county health departments.  It is not uncommon for local health department officials to collaborate with for-profit treatment providers in developing local healthcare policies –even when consumers frequently and repeatedly provide evidence of fraud, corruption, abuse, and negligence within local treatment facilities.  A strong statewide leadership base must be established if Maryland is to develop a robust and competent treatment system based on evidence-based best-practices.  

8)  Rehabilitation Not Incarceration: Too many of our transition-age children are being jailed for a treatable mental health disorder which they neither understand nor know how to control.  Incarcerating our state's young adults for symptoms of their substance use disorder is not only costly, unproductive and wasteful --but inhumane and cruel, as well.  We must pass compassionate and rational laws which treat individuals for their mental health disorder, rather than punish them for it. 

9)  SBIRT in Schools:  Our state's schools have failed to play even a minimal role in prevention or awareness efforts, even though a recent statewide survey showed that nearly 25,000 Maryland high school students had used heroin or prescription opiates illegally.  A simple Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol used by school nurses would go far to prevent problems in the early stages when efforts to treat have the highest rate of successful outcomes.  

10)  Family Peer Support:  Currently, there is no voice at the policy table for the families of individuals with a substance use disorder.  All other mental health disorders are represented by our state's mental health advocacy groups, including National Alliance on Mental Health (NAMI), Mental Health Association of Maryland (MHA), Maryland Coalition of Families (MCF), and On Our Own.  However, they have not represented our needs.  If policy that affects our children and our families is to be effective, it is imperative that we have an equal stake in shaping that policy. 

Sunday, December 7, 2014

Hogan to Declare State of Emergency Next Month

During a press conference in Frederick on Friday, Governor-Elect, Larry Hogan repeated his campaign promise to declare a state of emergency upon taking office.  Maryland will then be eligible for more federal funding and support for anti-drug measures.  He also plans to convene a summit of state and national experts on law enforcement, treatment and first-responders to focus on the problem.   Boyd Rutherford, Lieutenant Governor, will oversee the administration's effort to reduce heroin-related crime across Maryland.