Providers say Medicare Advantage hinders new methadone benefit – By Jessie Hellmann (Roll Call) / Jan 4, 2023
Providers say Medicare Advantage plans make it difficult for enrollees to receive much-needed, evidence-backed opioid treatment
In 2018, responding to a wave of overdose deaths, Congress passed legislation requiring Medicare to pay for services at opioid treatment programs for the first time.
But two years after Medicare began covering those programs, which use methadone and other medications to help reduce opioid use and overdose deaths, providers say their efforts are being hindered by Medicare Advantage — private insurance companies that administer benefits to about half of the Medicare population.
They say the tactics Medicare Advantage has long used to control health care costs can also delay or block access to patient care, which can be especially dangerous or deadly for someone with a substance use disorder.
“Once a patient reaches out for treatment, they’re not going to sit around and wait. If you don’t get people into treatment that day, you’ve kind of lost them to the street, and that’s what is the most concerning,” said Jay Higham, CEO of Behavioral Health Group, which operates 120 opioid treatment programs in 24 states.
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