State Lawmakers Aim to Close Gap for People With Drug Addiction Problems

Andrew Kitchenman | October 10, 2014 | Health Care
Boosts to Medicaid reimbursements, telemedicine are seen as ‘one step in the right direction’

State Sen. Robert W. Singer (R-Monmouth and Ocean)
New Jerseyans addicted to drugs often face limited choices as to where they can receive treatment, so legislators are looking to increase the number of available providers and beef up insurance coverage as part of a broader overhaul of drug prevention, treatment, and recovery.

More specifically, behavioral health providers would be reimbursed at a higher rate for Medicaid recipients, while federally qualified health centers would receive state grants to have remote consultations with specialists through two measures that are part of a package of 21 bills advancing in the Legislature. The first nine bills in this package were released by the Senate Health, Human Services and Senior Citizens Committee.

Sen. Robert M. Gordon (D-Bergen and Passaic) noted that many residents have been unable to find psychiatrists who can treat them for substance abuse or other behavioral problems.

“I’m not sure that anyone is getting the care that they need in the behavioral health area,” Gordon said.

Gordon cited a recent report by the Mental Health Association of New Jersey that listed the challenges in finding mental health providers. The report found that only 51 percent of psychiatrists listed on insurance sites were taking new patients.

“We need to do whatever we can to try to bring more practitioners into the field and to accept new patients, and raising the reimbursement rate is one way to do it,” Gordon said. “I think it’s long overdue.”

The reimbursement bill, S-2374/A-3717, would raise Medicaid reimbursements for 340 substance-abuse and mental health treatments that have proven effective. The rates would be raised from their current levels to match the market. Current payments can be as low as $8 for individual sessions and $14 for group therapy, according to Sen. Joseph F. Vitale (D-Middlesex), the bill’s sponsor.

Vitale said he would like to see Medicaid reimbursements raised more broadly than just for these services, but noted that the cost to the state would be significant.

“That amount is pretty staggering,” Vitale said of the total cost of raising all Medicaid reimbursements. “I’m all for it, but we have to have the resources to do it.”

Vitale described the bill as “at least one step in the right direction.”

Sen. Richard J. Codey (D-Essex and Morris) added: “Let’s be honest: In urban and rural New Jersey, you’re more likely to hit the lottery big than to find a psychiatrist to get help. I mean, it’s the truth. It’s sad, but it’s the truth. Psychiatrists should not be only for wealthy, suburban people. It’s as simple as that.”

Sen. Robert W. Singer (R-Monmouth and Ocean) expressed skepticism that New Jersey would have much success addressing the shortage of psychiatrists until it did more to make the state more attractive for doctors to practice. He noted that one bill that was intended to do that by forgiving some doctors’ student loans received a pocket veto by Gov. Chris Christie after the last legislative session ended.

“It is virtually impossible to recruit them to come into the state,” Singer said. “Unless you reimburse at some reasonable rate, it’s not going to happen, and if we don’t find some subsidy to encourage doctors to come into the state, it’s just not going to happen.”

Singer also noted that some residents who receive Medicaid coverage through the NJ FamilyCare program wouldn’t have access to the full range of addiction services available to those who are newly insured as part of the Medicaid expansion.

That’s because the federal Affordable Care Act didn’t require most people who were already eligible for Medicaid to receive all of the benefits required for other insurance plans under the law. This provision reduced the financial impact of the ACA on states.

Singer described this coverage gap as “just an error of Obamacare. It was a big mistake.”

The second bill, S-2376/A-3718, would establish a grant program to allow healthcare providers at federally qualified health centers to consult with medical specialists through the Internet. This could help make programs like Project ECHO permanent.

Project ECHO allows primary-care doctors to have weekly videoconferences with pain specialists — a specialty that is difficult for many low-income residents to access. Since many patients develop addictions to opioid drugs after having been prescribed the drugs to treat pain, it could be helpful to improve patient access to doctors who specialize in treating pain, and who could suggest alternative treatments, like physical therapy.

The Senate committee also released bills that would require providers that prescribe opioids to describe to patients the potential for addiction, as well as potential alternative treatments; require schools to maintain updated, evidence-based instruction on substance abuse; provide $5 million for substance abuse prevention programs; require the state to install receptacles for residents to throw out prescription drugs at police stations; require pharmacies and prescribers to tell patients how to dispose of opioid prescriptions.