Virginia moves to extend continuum of care under Medicaid | Addiction Professional Magazine Skip to content Skip to navigation

Virginia moves to extend continuum of care under Medicaid

August 10, 2017
by Gary A. Enos, Editor
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Virginia officials are targeting Medicaid beneficiaries in an ambitious continuum-of-care initiative to help combat the effects of the opioid crisis. Launched in the spring, the Addiction Recovery Treatment Services (ARTS) program is seeking to bring about provider capacity sufficient to allow same-day substance use treatment services for Medicaid clients presenting at any clinic or hospital.

According to information furnished to Addiction Professional by the Virginia Department of Medical Assistance Services (DMAS), “We will be working with stakeholders to help people realize the benefit is available for them to use. Some of the resistance in using the services may come from the stigma that still exists in our society against people who use these services.”

An increase in provider payment rates under Medicaid serves as a cornerstone of the state's effort, and is expected to fuel program expansions and the development of new programs by the state's addiction treatment providers. According to DMAS, “Rates for addiction treatment services had not been increased since 2007 when the General Assembly initially decided that Medicaid would cover a limited package of substance use disorder treatment, primarily for adolescents and pregnant women. Since providers were not getting paid for the actual cost of providing addiction treatment, the number of providers willing to care for Medicaid patients with addiction was severely limited.”

Under the ARTS program, Medicaid payment rates are being aligned with average commercial rates for services in the substance use continuum of care, according to the state. The enhanced substance use disorder treatment benefit took effect April 1. The benefit also applies to those covered under the state's children's health insurance program. Around 20% of plan members in these two insurance programs present with a substance use disorder, according to state officials.

Much of the design of the ARTS program was based on 2015 recommendations issued by a Governor's Task Force on Prescription Drug and Heroin Abuse that was created in 2014.

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Community-based addiction and recovery services covered under ARTS include residential treatment, partial hospitalization, intensive outpatient treatment, medication treatment for opioid use disorders, and case management. Peer support services have been implemented as of July 1.

Data from the state show that the enhanced benefit is expanding service capacity substantially, with available residential treatment providers increasing from 4 to 78 and opioid treatment programs increasing from 6 to 29 since ARTS was implemented.

State officials say that they also have streamlined provider credentialing and service authorization procedures with Medicaid health plans and the state's managed behavioral health care contractor. Preferred office-based buprenorphine treatment providers under ARTS are not subject to prior authorization requirements for Virginia Board of Medicine-recommended dosages of buprenorphine.  

Virginia Commonwealth University will lead a five-year evaluation of the initiative, with the first report to be submitted by next January in order to summarize service utilization in the first six months and its effect on hospital readmission and use of emergency services. Some of the substance use-related outcomes that will be tracked in the ongoing evaluation of ARTS will include overdoses, overdose deaths, and the number of infants born with neonatal abstinence syndrome.