Tag Archives: Suboxone

Opioid Emergency, Deductible Waivers,… and Methadone?

On May 3, 2017, the Governor of the State of Florida signed Executive Order Number 17-146 declaring that the opioid epidemic threatens the State with an emergency and that, as a consequence of this danger, a state of emergency exists. Also, in the executive order, the Governor directed the State Health Officer and Surgeon General to declare a statewide public health emergency, pursuant to its authority in section 381.00315, F.S. On June 29, 2017, the Governor signed Executive Order Number 17-177 to extend the state of emergency declaration.

The Department of Children and Families (DCF) was recently awarded a two-year grant to address this opioid epidemic.

Many Floridians involved in this discussion were excited that expansive use of Medication-Assisted Treatment and other modalities would be used to address the growing epidemic within underserved populations using a medical model, rather than exclusively through traditional counseling treatment.

However, what appears to be occurring, though more information still needs to be obtained, is that DCF will use these funds in part to expand onlyMethadone Medication-Assisted Treatment services in needed areas of the state as part of a comprehensive plan to address the opioid crisis. We do not believe this includes Suboxone or Vivitrol.

This also does not appear to help the majority of Floridians who may have insurance but cannot cover the costs of treatment due to treatment plans that continue to demand exorbitant co-pays and deductibles for SUD treatment. Stated otherwise, you either have SUD or do not. The economic decision of whether to pay a deducible becomes secondary.

While Florida does allow a statutory “deferral” of payment of deductibles in order to obtain payment, this allowance has been sometimes abused in the past with faux attempts to collect the deductible after-the-fact.

Florida mandates “balance billing” which means the provider MUST use all reasonable methods to collect on the balance. The fees for services are published and provided in advance as required by DCF rule, so the patient and their family know or have access to know what they are getting themselves into.

Ironically, perhaps, the “bad” providers who “forgive” the debt are alleged to have committed “Patient Brokering” for “inducing” a patient to treatment under the guise of waiving the co-pays and deductibles.

The “good” providers that follow the law and make every reasonable attempt to collect on the deductibles are called “heartless” or “ruthless” for “taking advantage of a family who is otherwise suffering a health tragedy.”

This law certainly must be changed.

For now, DCF has to revise the licensure requirements since methadone programs were the only type of service provider issued licenses based upon a needs assessment.  DCF has determined there is a critical need for more methadone medication-assisted treatment providers.

This rule makes changes to permanent Rule 65D-30.014 F.A.C., which is attached for reference, relating to licensure requirements for methadone medication-assisted treatment programs.

Negative Press Causing Referrals to Florida to Come Into Question

The Portland Press Herald reported on July 19, 2017 in the article “Operation Hope stops sending clients out of New England for opioid addiction treatment” about how the Scarborough (Maine) Police Department’s Operation Hope has stopped sending clients out of New England for treatment for opioid addiction, largely because of negative media about alleged unscrupulous programs, especially in Florida (a story published in May by STAT, a health journalism website that partners with The Boston Globe, detailed alleged insurance scams and referrals to Florida clinics where patients were receiving little or no treatment).

Launched in 2015, Operation Hope was conceived as a way for police to channel addicts who sought help into a treatment program as an alternative to criminal prosecution on drug-related charges.

In most cases, getting help from Operation Hope meant flying out of state – to Florida or one of eight other states – because Maine lacked treatment opportunities. In the program’s first six months, four out of five Operation Hope participants headed out of Maine, mostly to clinics in Florida, Arizona and Massachusetts.

“We always wanted to help people closer to home, but we really had no other choice. That was the only way to get people help,” said Steve Cotreau, program manager at Portland Community Recovery Center. The nonprofit social support center for people in recovery has helped with Operation Hope placements.

With the current black-and-white approach that many law enforcement agencies are taking with regard to “regulation” of treatment providers, many good providers are electing to close up shop due to lack of regulatory guidance. When the only guidance available is a knock at the door from a detective claiming you have violated the law, when the lawyers themselves may disagree whether the law was violated, but it is to be “left up to the judge and jury” to determine one’s fate, many good providers are simply walking away.

There is an absolute vacuum of publicly-funded beds in Florida, and nationally. Even when there is some modicum of availability, these facilities are generally not accessible to persons who do not qualify as being impoverished, and are often staffed by persons who lack the experience or education to be administering what is becoming an overwhelmingly medical modality.

The ignorance from the regulatory bodies about how the private sector must be allowed to work is impeding innovation as well as necessary investment in technologies for growth. A truly progressive society would stop complaining and fully support the treatment industry altogether.

The apparent restriction of prosecutorial discretion for purposes of achieving popular political gains is not only short-sighted, but also has a significant negative impact upon the substantial legitimate employment that the industry provides, along with choking off the ancillary revenue that local businesses experience from developing recovery communities.

We will simply go from one crisis, to another.