With demand for drug treatment soaring due to the opioid epidemic, addiction service providers are looking for ways to get people who want help off waiting lists and into their facilities.
For years, the federal Centers for Medicare and Medicaid Services (CMS) – the agency that pays the bills for many people in rehab – has prohibited the use of federal dollars for addiction treatment in facilities with more than16 beds.
Ideastream’s Be Well health reporter Marlene Harris-Taylor and ideas host Rick Jackson had a conversation about how things are changing around the 16-bed rule specifically for rehab facilities in Ohio and at the federal level.
Officials at Ohio Medicaid received permission from CMS earlier this year to change its payment structure and the way it reimburses agencies that provide alcohol and drug treatment.
These changes have opened the door so providers can finally expand beyond 16 beds in their facilities and still receive reimbursement payments from Medicaid, said Jim Tassie, assistant director Ohio Medicaid.
The LCADA Way in Lorain is one of the first treatment agencies in northeast Ohio to take action now that the door is open, said Tom Stuber, executive director. The agency is moving quickly to renovate its women’s rehab facility.
“Unfortunately many organizations are limited by the size of their buildings. We acquired back in 2004 a 100-bed nursing home, which unfortunately we could only put 16 women in. Now we’re gonna go through some renovations. We are looking at hiring additional staff and our intent that by the end of this year we hope to be at 30 beds,” Stuber said.
California, Maryland, Massachusetts and New York have also received waivers from the federal government from the 16-bed rule but Ohio has not applied for a waiver, Tassie said.
Ohio is now considering applying for an official waiver to send a clear message to service providers they can now expand, Tassie said.
The rule, known as the IMD exclusion, has been a part of the Social Security Act since 1965. (IMD stands for Institutions for Mental Disease.) It was intended to prevent Medicaid funds from covering treatment in state psychiatric hospitals, which were far more common when it was written in 1965.
The federal government included residential programs for substance abuse under the exclusion.