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Last week, we wrote about a demonstration program that allows state Medicaid programs to expand the continuum of care for addiction treatment benefits, increase capacity, and improve care coordination (see The Market Impact Of The New Medicaid Addiction Treatment Benefits). One of the major components of the demonstration is a waiver that allows states to provide residential addiction treatment services in institutions for mental disease (IMDs) with more than 16 beds.
In addition, there have been several state initiatives to expand the number of residential addiction treatment beds available in the state. At the beginning of the month, Governor Christie of New Jersey announced a plan to create 846 residential treatment beds with 5% set aside for Medicaid enrollees. Private provider organizations will be responsible for operating the facilities and guaranteeing to make beds available within two years (Christie to add nearly 900 beds in N.J. to treat drug addiction, mental illness). Massachusetts is also working to increase the number of addiction treatment beds to 850 by adding 400 beds in FY2017 and 450 beds in FY2018 (see Massachusetts Medicaid To Expand Addiction Treatment Benefit).
Finally, significant investment capital is going into the creation of new residential addiction treatment capacity. Here are just a few of the announcements we’ve covered recently:
As I look at this issue and think about the cumulative effect of existing residential treatment capacity and the growing number of residential treatment beds, the question that comes to my mind is this: How many residential treatment beds do we need? The math is simple — the prevalence of the disease, the average incidence of relapse, the characteristics of consumers with addictions who need residential addiction treatment, and (if you’re referring to paid demand) the proportion of those consumers without insurance. But the assumptions are controversial.
The relapse incidence for addiction is also a matter of research. According to a JAMA report on drug dependence, only 40% to 60% of consumers with an addiction remained continuously abstinent in the year following discharge from treatment (see Drug Dependence, a Chronic Medical Illness). While these numbers seem high, it is important to note that they are comparable to other chronic conditions, such as diabetes, hypertension, and asthma (see Treating Opioid Addiction as a Chronic Disease).
The number and proportion of people without insurance for addiction treatment has declined over the past five years. They fall into two groups: the consumers without insurance and the consumers with insurance who are not covered by the parity provisions. The first group is 28.8 million, or 9% of the population. The second group includes consumers working for employers with fewer than 50 employees (an unknown number) and consumers enrolled in Medicare, which is 57.4 million, or 17.6% of the population.
What is controversial is determining the characteristics of consumers who need residential treatment for addiction instead of outpatient treatment. The American Society of Addiction Medicine (ASAM) relies on six consumer dimensions to determine whether a consumer needs to access to residential treatment. Those dimensions include acute intoxication/potential withdrawal; biomedical conditions and complications; emotional, behavioral, or cognitive conditions and complications; readiness to change; relapse, continued use, or continued problem potential; and living environment (see What is the ASAM Criteria?). ASAM suggests that residential treatment is most appropriate for those who have not yet acknowledged their addiction, lack access to housing, have a high-risk of relapse, or have other co-morbid/co-occurring conditions. But the interpretation of those six consumer dimensions and the “appropriate” criteria are the subject of considerable debate.
To continue the discussion on the appropriate level of residential addiction treatment services, be sure to join us on June 6, 2017, at The OPEN MINDS Strategy & Innovation Institute for the session, “The Shift From Residential: Keeping Up With The Changing Addiction Treatment Landscape.” And I would welcome your perspective on this issue — do we have enough residential addiction treatment beds? Email us at email@example.com or tweet us @openmindseditor.
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