50-State Table: Other State Financing of
Medication-Assisted Treatment for Opiate Addiction

April 1, 2008

Arizona

1 N/A
2 N/A
3 N/A
4 N/A
5 Defined by Executive Order of Governor renewing capacity to treat opiate addiction

California

6 Medi-Cal is the only source of funding for Suboxone in physicians' offices.
7 Chapter 75 (Statute of 2006) Senate Bill 84. established the Department of Alcohol and Drug Program’s Offender Treatment Program. The Offender Treatment Program was established to enhance accountability and improve outcomes for the Substance Abuse and Crime Prevention Act of 2000 (Proposition 36). This legislation increased the State’s Fiscal Year 2006-07 Budget of 25 million and continued in State Fiscal Year 2007-08 Budget of 20 million. The counties plan and commitment to utilize the funds for the purposes of the program which may include but are not limited to enhancing treatment services for offenders assessed to need them including residential treatment and narcotic replacement therapy.
The Nonviolent Offender Rehabilitation Act of 2008 is a statewide ballot initiative for California voters in November 2008. This initiative proposes to expand medication-assisted treatment which includes opioid agonists treatment to nonviolent drug possession offenders as well as other ancillary services such as housing assistance, childcare, transportation, court appearances, vocational and literacy training, and family counseling.

Connecticut

8 For Ambulatory Detox, not ongoing or maintenance treatment
9 The term "chemical maintenance" is being substituted for the term "methadone maintenance" and the following new language is being added: “Chemical maintenance treatment: A non-residential, medically necessary service provided in a state-operated facility, or in a facility licensed by the Department of Public Health to offer medically necessary chemical maintenance treatment. Chemical maintenance treatment involves regularly scheduled administration of a SAMHSA-approved medication, prescribed at individual dosages, and includes a minimum of one clinical contact per week. More frequent clinical contacts shall be provided if indicated in the individual’s recovery plan. After six months of a general assistance behavioral health program recipient’s successful participation in treatment, a minimum of one clinical contact per month shall be provided. More frequent clinical contacts shall be provided if indicated in the individual’s recovery plan.”

Delaware

10 We also use general fund dollars to fund the same two outpatient NTP programs in Delaware.
11 All of our contracted providers are encouraged to use best practices in treating clients including use of medications. All contractors must meet state licensing standards.

Florida

12 Access to Recovery grant (federal) purchased Buprenorphine at a dosage rate of $38 with a maximum of 50 dosages per client.
13 Access to Recovery grant (federal) purchased Buprenorphine at a dosage rate of $38 with a maximum of 50 dosages per client.
14 Injectable Naltrexone (Vivitrol) is being piloted through 3 provider agencies for chronic, alcohol dependent clients who have otherwise been unsuccessful in multiple treatment programs. Medicaid will pay for pill form of Naltrexone only.
15 The Department of Children and Families is in the process of revising its administrative rule governing substance abuse services, including the administration and regulation of medication-assisted treatment. Due to the national and state increases in the number of methadone deaths, the State is tightening requirements in its rule for take home medication and the transfer of clients from one phase of treatment to the next. Additionally, we are pushing for stricter enforcement of state and federal rules. The majority of deaths occurring in Florida have been determined to be from sources other than Opioid Treatment Programs. The changes in rule will help to ensure that OTPs do not experience any increases in methadone-related deaths.

Illinois

16 DASA does not at this time pay for office based services
17 As stated in response to prior questions, treatment agencies funded by DASA may utilize contract and other funds to support use of medications.
18 DASA does not at this time pay for office based services
19 As stated in response to prior questions, treatment agencies funded by DASA may utilize contract and other funds to support use of medications. DASA uses a mix of federal, state and other funds to support treatment services throughout Illinois.

Indiana

20 SB 157
21 Yes, once the SB 157 is passed Indiana will develop rules for OTP.

Iowa

22 Pay for counseling but not dosing or lab.
23 Pay for counseling but not dosing or lab.

Kentucky

24 In discussion

Louisiana

25 State SA funding only covers services provided in State-operated clinics
26 Budgetary request for additional funding prepared for 2008 legislative session to cover methadone maintenance treatment in pregnancy and Buprenorphine/Suboxone detox; Legislation would be HB 01 if approved.

Maine

27 ME has an RWJ Advancing Recovery grant that supports 3 pilot sites where state funding pays for medication for clients with no other payer source.
28 State funding is provided to the NTP’s for Bridge funds for clients at an NTP that are not covered by Medicaid or another 3^rd party payer. These funds could be used for Bup.
29 State is funding Vivitrol pilot sites with GF dollars.
30 No current bills. We are funding 3 Overdose Prevention projects in south, central, and northern Maine.
31 1. Working on regulatory changes in Medicaid funding statutes to integrate MH and SA so that medication management for all medications is covered.
2. Working with Medicaid formulary advisory group on policies and education/training of group and other physicians on rx of pain medications and bup/suboxone.
3. Conference in April of 2008 for providers on MAT in treatment and physician practices.
4. TA with CSAT for training for physicians and practitioners in safe management of pain rx practice related to opiate abuse, addiction, and overdose risk (diversion).

Massachusetts

32 Implementation of guidelines and PA process

Missouri

33 While being a covered item, currently NTPs are not utilizing SAPT funding for Suboxone treatment.
34 While being a covered item, currently NTPs are not utilizing SAPT funding for Suboxone treatment.

New Jersey

35 DAS has developed a Needle Exchange Treatment Initiative pursuant to the Bloodborne Disease Harm Reduction Act (P.L. 2006, c.99), which includes mobile medication/outreach/office based services, supportive housing, and medically managed sub-acute detoxification. The mobile medication units are situated in four cities to provide methadone and suboxone in Atlantic City, Camden, Trenton and Paterson.
36 Providers of drug treatment services must have in place established, facility-wide policies which prohibit discrimination against clients of substance abuse prevention, treatment and recovery support services who are assisted in their prevention, treatment and/or recovery from substance addiction with legitimately prescribed medication/s, without limits to frequency and duration.

New Mexico

37 The State of New Mexico has general funds available to pay for suboxone. These funds are available only for prescriptions written by providers contracted with our behavioral health vendor and a prior authorization is required.
38 The State of New Mexico has general funds available to pay for suboxone. These funds are available only for prescriptions written by providers contracted with our behavioral health vendor and a prior authorization is required.
39 The State of New Mexico has general funds available to pay for naltrexone. These funds are available only for prescriptions written by providers contracted with our behavioral health vendor and a prior authorization is required.
40 The State of New Mexico has general funds available to pay for naltrexone. These funds are available only for prescriptions written by providers contracted with our behavioral health vendor and a prior authorization is required.
41 The Medical Assistance Division is considering adding an expanded benefit for outpatient substance abuse treatment.

New York

42 OASAS block grant funding is not used to fund specific medications. Block grant monies fund treatment programs.
43 OASAS block grant funding is not used to fund specific medications. Block grant monies fund treatment programs.
44 New rate codes to provide enhanced reimbursement for Suboxone® (buprenorphine) to methadone maintenance treatment programs (MTPs) was implemented in 2007, and will be continued in 2008.
45 OASAS funding initiatives are not related to specific substance types of abuse or dependence; e.g., opiate abuse. They relate to service delivery and modalities. For instance, a funding initiative might be to add residential chemical dependence beds in the state.
46 OASAS is revising their regulations that cover opiate treatment. Medication will be addressed in these regulations.

North Dakota

47 No methadone clinics in ND
48 No methadone clinics in ND

Ohio

49 In Ohio, ODADAS licensed opioid agonist programs are limited to the use of only liquid methadone as the opioid agonist. Therefore, they can not administer Buprenorphine as an ODADAS treatment service.
ODADAS licensed opioid agonist programs are owned and operated by business entities which also own and operate ODADAS-certified treatment programs; in fact it is a requirement. Under this scenario, while they can not prescribe or dispense the Buprenorphine as an ODADAS service, they could be partnering with community based physicians as a treatment (counseling) referral source to assist them in meeting their DATA 2000 referral source requirement.

Oklahoma

50 These are requested through the Oklahoma Medicaid state budget process. No bill numbers have been assigned to the request at this time.
51 These are requested through the Oklahoma Medicaid state budget process. No bill numbers have been assigned to the request at this time.

Pennsylvania

52 The PA Dept of Public Welfare has submitted a plan for Suboxone to be included in the Special Pharmaceutical Benefit Package on a limited basis.(one year capped benefit)
53 State BHSI D&A funds administered by the Dept of Public Welfare Office of Mental Health and Substance Abuse services can cover a full continuum of care including NTPs/Methadone Clinics.

South Dakota

54 We do use general funds during the medical detoxification process at one facility in the State.

Tennessee

55 Alcohol and Drug Abuse Services recently have moved to the Department of Mental Health and Disabilities. New rules for Methadone will be approved and enacted.

Texas

56 DSHS uses Federal Block grant funds to pay for buprenorphine services in NTP’s funded by the state for treatment services.

Vermont

57 There will be further limitations placed on Subutex in 2008, but not on Suboxone.

Virginia

58 There is a specific appropriation from the State General Fund currently funding 5 Community Service Boards, from 2006 and ongoing.
59 In 2007, DMHMRSAS added Suboxone to its community planning formulary to increase availability to Community Service Boards

Washington

60 Washington State offers Medicaid coverage for treatment using Suboxone in a physician’s office. Coverage includes physician visits and lab tests. Counseling is not covered in the physician’s office. Counseling services must be provided, by referral, to a DASA certified Chemical Dependency treatment program.
Other sources of state substance abuse funding include:
• Violence Reduction and Drug Enforcement
61 NTP’s are required to meet WAC 388-805-700 through 750 and 42 CFR, Part 8.12 regarding Certification of Opiate Treatment Programs.
Other sources of state substance abuse funding include:
• Violence Reduction and Drug Enforcement
62 Washington State offers other state funded coverage for treatment using Naltrexone in a physician’s office. Coverage includes physician visits and lab tests. Chemical dependency (CD) counseling services provided in a physician’s office are not a covered benefit. CD counseling services must be provided, by referral, at a DASA certified Chemical Dependency treatment program.
Other sources of state substance abuse funding include:
• Violence Reduction and Drug Enforcement
• Criminal Justice Treatment Account
63 Washington Medicaid has successfully operated a Narcotic Review Program (NRP) which was originally based on Medicaid clients receiving high numbers of narcotic prescriptions triggering prior authorization. The next step in furthering the Opioid Dosing Guidelines in Washington will be to propose using doses >120 Morphine Equivalent Dose (MED)/day as a new trigger for the NRP and to require pain contracts for those patients receiving >120 MEQ/day.
The HRSA website for additional information is: http://fortress.wa.gov/dshs/maa/pharmacy/ToolKit.htm.

West Virginia

64 It is Medicaid funding, I am not sure what limitations or requirements are involved but do know it is rarely accessed in West Virginia.
65 A bill has been introduced House Bill 4668 which would create the West Virginia Addictions Treatment and Recovery Fund which would set aside 5 cents per ounce of the uniform price of alcoholic liquors sold in West Virginia to this fund and set them aside for use by community-based support programs and community-based corrections programs. It would be for treatment of all drugs of abuse not exclusively opiates. Update…..this bill did not make it through the committee process. It will likely be introduced next year again….
66 Planning to offer additional narcotic treatment services in 2008. We are trying to encourage the expansion of buprenorphine through our participation in the Robert Wood Johnson Advancing Recovery grant project.

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50-State Table: Other State Financing ofMedication-Assisted Treatment for Opiate Addiction