Tag Archives: treatment

Recommitting to the Mission

Dear Friends and Subscribers:

First, Happy Holidays to all. This is my favorite time of year, mostly because this is when the new Star Wars movies come out.

But it is also a time of reflection, appreciation, gratitude, and recommitting ourselves to your own life’s purpose and mission.

As we all move into 2018, while the treatment and recovery residence business communities have taken their unfair share of lumps in the press (since it is widely accepted as fact that far more good comes from the Recovery Business Community, than bad), we must continue to press on to change the narrative that people with Substance Use Disorders are not second-class/disposable human beings; that while “recovery” may begin in treatment, it is only fully realized in a supportive recovery community setting; and that we are all in this together – the afflicted, the first responders, citizens, government officials, parents, normies, lawyers, doctors, legislators, DCF, AHCA, DOH, and on and on.

But to that point of “recommitment of purpose,” I must admit a rather large failing that I have. I tend to want to see only the good in people and therefore tend to trust more than perhaps I should.

I have been deceived, actually lied to, manipulated, and used as a tool by clients who (I came to learn too late), never really wanted to heal our nation, but rather whose sole and exclusive purpose was to make money off of the pain.

That said, if I was ever to get a tattoo, it would say “It’s ok to do ‘well’ by doing ‘good’.”

I am a firm believers that profit motivation drives innovation, creativity, and the new discoveries that have always made our state and nation the greatest place on Earth.

I fully, 100%, support the private sector as the solution to getting our way out of this addiction crisis, which is far beyond a public health emergency. It is a national crisis that simply shows no sign of receding. It may sadly become to new “normal,” much like mass gun shootings in malls, movie theaters, churches, and schools.

However, and lately, I find myself getting worn down from it all. I become, admittedly, cranky. I become cantankerous. I become distrustful. I become jaded. I become angry and mean and resentful.

Then I am reminded of that saying attributed to the Buddhist faith that: “Holding onto anger is like drinking poison and expecting the other person to die.”

Maybe I missed out by not being addicted and going through recovery.

I find that those friends who have had to endure the life crucible of addiction and recovery to be at a different and oftentimes better place that I am. And very likely the reason why the Recovery Community is the best “community” that I have ever encountered in my lifetime as a native third-generation South Floridian.

As the New Year and holidays are upon us, I wish each of you nothing but the best and only ask in return that you, too, recommit yourself to the purpose and mission and privilege of working with and among these most exceptional people.

Will Addiction Treatment Be Eliminated from Obamacare Requirements?

The federal Centers for Medicare & Medicaid Services (CMS) proposed a federal rule late Friday aimed at giving states more flexibility in interpreting the Affordable Care Act’s “Essential Health Benefits” mandate as a way “to lower the cost of individual and small group health plans.”

Perhaps most notably, CMS’ proposed rule would allow states to alter their essential health benefits benchmark plan annually, beginning as early as 2019.

The Affordable Care Act set forth ten (10) categories of essential health benefits, including mental health and substance use disorder treatment.

“Consumers who have specific health needs may be impacted by the proposed policy,” the agency said. “In the individual and small group markets, depending on the selection made by the state in which the consumer lives, consumers with less comprehensive plans may no longer have coverage for certain services. In other states, again depending on state choices, consumers may gain coverage for some services.”

The agency in 2017 proposed standardized health plan options as a way to simplify shopping for consumers on the federally run marketplaces. The CMS said it would eliminate standardized options for 2019 to maximize innovation. “We believe that encouraging innovation is especially important now, given the stresses faced by the individual market,” the proposed rule states.

The Trump administration hopes to relax the ACA’s requirements and provide as much state flexibility as possible through administrative action, following the collapse of congressional Republican efforts this year to make those changes legislatively.

However, the EHB benchmark plans for mental health/substance abuse must comply with the Mental Health Parity and Addiction Equity Act of 2008 (“Parity Act”).

While we do not believe that any state can eliminate or reduce benefits for drug and alcohol treatment, by reducing benefits for other medical health care counterparts, they could strategically and effectively compromise reimbursements, even under the Parity Act.

The 2019 Notice of Benefit and Payment Parameters (PDF), released Friday.

The Positive Economic Impact of the Treatment Industry and Recovery Community

The health care industry is the job engine of many parts of the U.S., aided by funding as a result of the Affordable Care Act.

Florida, California, Texas, and other states are no different, specifically and including the number of well-paying jobs for professionals and para-professionals in the drug and alcohol treatment industry.

While some cities would prefer not to have treatment providers and recovery residences in their jurisdiction, that really cutting off the proverbial nose to spite one’s face.

We don’t have the numbers (yet) but no one will doubt the major economic driver that the treatment and housing industry is for the South Florida region.

According to a newly-released report by the New York Times in relation to Republican efforts to “repeal and replace” the Affordable Care Act:

“Whatever happens, the economy of every state will be affected. Across the country, the health care industry has become a ceaseless job producer — for doctors, nurses, paramedics, medical technicians, administrators and health care aides. Funding that began flowing in 2012 as a result of the Affordable Care Act created at least a half-million jobs, according to an analysis by Goldman Sachs.”.

Similarly, universities such as Florida Atlantic, University of Miami, and Nova Southeastern, that have strong social work and other behavioral clinical programs, rely upon the robust treatment industry and recovery community for employment for their graduating students.

An economic impact review by the American Hospital Association concluded that workers’ earnings combined with their spending on groceries, clothing and the like generate millions of dollars per year in economic activity and helped create thousands of jobs beyond their own. “The goods and services hospitals purchase from other businesses create additional economic value for the community. With these “ripple effects” included, each hospital job supports about two additional jobs, and every dollar spent by a hospital supports roughly $2.30 of additional business activity.”

Similar results apply to the robust treatment and housing industry within Palm Beach County and throughout Florida, as well as the rest of the nation.

In the effort to regulate the treatment and housing industry, we have used chemotherapy to rid the scourge of bad players from the playing field. However, in doing so, we may have found that many good providers have been scared off too, fearful that regulators and law enforcement are using this is a pre-text at the behest of the electorate, where one may be able to “beat the rap” but will be unable to “beat the ride.”

In the meantime, recognition of the positive economic benefit that this industry has on Florida and the entire nation should be further studied, recognized, and supported.

The alternative is to eliminate the entire system, and to leave those suffering with no alternatives whatsoever.

The Continued Evolution of Treatment

“Intensified post-treatment support at Caron illustrates potential of monitoring”

Caron has been offering and continues to extend to patients one year of post-treatment support free of charge, with monthly phone contact from the treatment facility designed to ease the transition between treatment and life back in the community. Caron leaders were observing that at around the six-month mark, a worrisome number of individuals were falling out of touch with the organization, for a number of possible reasons. “In some cases, it could be associated with the shame of relapsing,” says Knepper.

Read about it here!

The Future of Substance Abuse Treatment

I just received the attached from Addiction Professional Magazine, which, in my opinion, is a must read about the antiquated system of substance abuse treatment models that are employed and how existing RESEARCH needs to be reviewed and implemented.

Quote: [Integration] is not a gift to the mental health and substance abuse field. We¹re not being given something just because it’s fair, just because it’s our time, or just because there¹s a Democratic administration. You can¹t run the rest of healthcare if you don¹t manage substance use and mental health.

Me: Housing is an integral part of this equation as well. The best treatment outcomes occur when safe and secure housing exists. It’s a human necessity.

This is a great article that discusses Integration:
Integration demands highest standard of care

Wellington town hall meeting to address ‘sober homes’

Anyone with an interest should absolutely attend this meeting. Don’t let it be a one-decided discussion. Let them see the “Faces of Recovery” as well as hear from you that you and those you compassionately serve will not tolerate being treated as a second-class citizen due to your/their disability. I am reminded the following poem “First they came” is a famous statement and provocative poem attributed to pastor Martin Niemöller about the cowardice of German intellectuals following the Nazis’ rise to power and the subsequent purging of their chosen targets, group after group.

First they came for the Socialists, and I did not speak out– Because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out– Because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out– Because I was not a Jew.

Then they came for me–and there was no one left to speak for me.

Get details here!

OIG’s 2014 plan promises scrutiny for behavioral health

By Dennis Grantham, Editor-in-Chief of Behavioral Healthcare

In a recent story, “Compliance programs stress effectiveness” (Behavioral Healthcare, Nov./Dec. 2013 issue), Fabio van der Merwe, director of quality improvement and compliance at DeKalb Community Services Board (Atlanta, Ga.) noted that each year, the Office of the Inspector General (OIG) for the Department of Health and Human Services releases an annual work plan.
This plan, he says, “puts compliance officers ‘on notice’ as to the focus of federal Medicare and Medicaid enforcement activity for the coming year.” In its recently unveiled 2014 work plan, the OIG committed to continuing a range of investigative activities involving behavioral health.

Read the full article here.

Letter from DCF RE: Patient Brokering

Many of you have called me regarding letters you may have received from DCF regarding Patient Brokering. Please be aware that the letter has been sent to all providers and not to anyone specifically accused of any wrongdoing.

That said, you should remain vigilant that you are closely monitoring any activity by your staff that could be construed to violate s. 817.505, Fla. Stat., the Patient Brokering Act. I have attached a copy for your records.

For purposes of the Act, the repeat question I receive is regarding how to effectively and legally use marketing companies to obtain referrals for new patients. The provision in the statute which addresses that point can be found within subsection (i) which allows for:

Payments by a health care provider or health care facility to a health, mental health, or substance abuse information service that provides information upon request and without charge to consumers about providers of health care goods or services to enable consumers to select appropriate providers or facilities, provided that such information service:

1. Does not attempt through its standard questions for solicitation of consumer criteria or through any other means to steer or lead a consumer to select or consider selection of a particular health care provider or health care facility;

2. Does not provide or represent itself as providing diagnostic or counseling services or assessments of illness or injury and does not make any promises of cure or guarantees of treatment;

3. Does not provide or arrange for transportation of a consumer to or from the location of a health care provider or health care facility; and

4. Charges and collects fees from a health care provider or health care facility participating in its services that are set in advance, are consistent with the fair market value for those information services, and are not based on the potential value of a patient or patients to a health care provider or health care facility or of the goods or services provided by the health care provider or health care facility.

Should you have any questions or concerns about your compliance with this provision, please don’t hesitate to give us a call.

Insurance Fraud – More Fraud in the Substance Abuse Drug Screening Urinalysis Industry

Meant to include this one earlier, brought to our attention from our friends over at PathologyBlawg.com

A chain of opiate addiction recovery centers, headquartered in Harrodsburg, Ky., and a Russell Springs, Ky., clinical laboratory, along with two physician owners, agreed to pay the U.S. Government millions of dollars to resolve civil allegations that they fraudulently billed federal health care programs for medically unnecessary and excessive urine tests.

Strangely, DOJ and the states Attorney Generals don¹t see to be concerned about the same abuse in the private insurance sector.

However, something to chew on – are medical plans obtained through the Federal Healthcare Exchange (or a state exchange) elevated to a federal health care program. I assume the answer is “no” as a mere result of legal definition, but we will wait and see.

Still, the fox appears to be the only one watching the hen house.

Check out these articles:
Kentucky Addiction Treatment Center, Clinical Laboratory and Two Physician Owners to Pay $15.75 Million to Resolve Allegations of Fraudulent Urine Drug Testing

Attorney states cash kickbacks from urine drug screen lab are perfectly legal

Blue Cross Accuses Drug Test Co. Of $36M Fraud Scheme

Further Discussions on the Marketplace Impact of the Affordable Care Act

As initially predicted, the marketplace is moving towards consolidation of services and this may likely begin to see capture in the substance abuse treatment services in the coming 12-36 months. Possibly later.

The trends leading to this uptick in deals over the past year or so increasing health care costs, growing demand for services, consolidation of doctor groups were in place before the law. But experts say the ACA magnified their importance and expedited hospitals’ response.In one sense it just means there’s a higher need for medical office buildings. At the same time, hospitals are trying as they acquire physician groups to gain market share and use the physicians as a gateway into the market, said Ross Yustein, chair of Kleinberg Kaplan Wolff & Cohen PC’s real estate group, which has an unusual expertise in medical office building development deals.

Read this article about Hospitals Turn To Off-Campus Offices Under ACA