Expanding Access to MAT: The Maine Experience

1. Expanding Access to MAT: The Maine Experience Linda J. Frazier, RN, CHES, MA Treatment Manager Maine Office of Substance Abuse, DHHS 2009 NIATx Summit & SAAS National Conference Tucson, AZ

3. Context of Maine MAT Project 9 OTP Clinics serving 3,518 clients receiving Methadone, capacity is 4,810 5 Original MAT Pilots + 5 New Pilots (6/09) SOTA – State Opiate Treatment Authority History of using Medicaid Funding for treatment; State Plan includes and supports key components OSA seen as authority on Treatment Issues; Solid Relationships across and within state systems and the provider community

4. Key Activities Partnership & Shared Aims – Rapid Cycle PI Surveys, Chart Audit, Focus Groups – Provider Staff & Consumers Implementation of Non Discrimination Language in July 2007 Contracts Implementation of Pay for Performance Contracts July 2007 Changes to TDS Data System July 2007 – Added questions on Evidence Based Practices, MAT, Access/Retention

5. RIDER E: PROGRAM REQUIREMENTS(SUBSTANCE ABUSE SERVICES) NON-DISCRIMINATION 13. Providers receiving grant funds from OSA will not discriminate against clients who are using legitimate medications to assist their recovery and will not have policies that allow them to refuse admission to treatment or to discharge clients from treatment based on the use of legitimate addiction medications.

6. Partnership With MAT Agency Pilot Sites Four original AR MAT pilots, 2 added vivitrol sites, LC with these and five additional sites April 2009. ASAM LOC written into licensing regulations 2006. Develop treatment processes & protocols – ID need for medication and access to funds, patients right to have MAT, address internal barriers like staff attitudes. OSA sponsored training to address staff education and identified barriers of prejudice and mis-information about MAT. Site visits in July 2009.

7. Support for MAT Systems Change Continued support for MAT – Coaching, Learning Session Participation State General Funds for MAT Medicaid Reimbursement for Suboxone without Prior Authorization for Addiction Treatment Co-sponsorship & Support for Development of ROSC Education & Training Evaluation of MAT in Addiction Treatment Consulting Medical Director

9. STOP Selling What You Have START Selling What They Need STOP Talking, START Doing IBM.com/doing/uk Heathrow Airport Billboard October/December 2008

10. Primary Barrier People don’t know what they don’t know

11. Challenges Addiction is a Chronic Health Condition! Information & technology transfer Policy & Regulatory Changes – connecting the dots Preventing Prior Authorization and benefit limitations specific to Medications for Addiction Treatment Funding, Policy, & Professional Silos Using data results to support the above and make the business case for sustaining and expanding access to MAT

12. Results Four original RWJF Advancing Recovery MAT Pilot Sites

13. Percent of Admissions with any MAT

14. Percent of non-methadone admissions with MAT other than methadone

15. Percent of admissions with Buprenorphine

16. Reduced use at discharge: AR agencies

17. Percent Abstinent at Discharge

18. Successful Whole Systems Change Requires ART Trust & Respect Identified Common & Shared AIMS AND Mutual Accountability & Transparency Common Shared Language – Between professional fields and the recovery community Cultural Competency Positive Role Models, Access to Coaching/Recovery Support