Improving Access To Treatment For Opioid Use Disorder

Program Provides Funds to Facilities Offering Opioid Use Disorder Treatment

In partnership with the Arkansas Department of Human Services, the UAMS Psychiatric Research Institute’s Center for Addiction Services and Treatment is providing funds to facilities across Arkansas offering medication-assisted treatment to patients with opioid use disorder. The money will allow medical providers to offer treatment to patients without insurance or the ability to pay for services.

The funds will cover expenses including the cost of medication, hiring peer support specialists, providing treatment services and even travel costs for patients using medication-assisted treatment.

To learn more about these funds and how to receive them, call 501-526-8459 or 833-872-7404 or email Anner Douglas at ADouglas2@uams.edu.

Medication-assisted treatment involves the use of medication to relieve cravings and withdrawal symptoms along with counseling and support to overcome the use of opioids. This includes methadone, which can only be dispensed through an opiate treatment program, products containing buprenorphine that require a federal waiver for prescribers and injectable naltrexone, which does not require special qualifications for prescribing.

Arkansas substance abuse and mental health treatment centers and other health care organizations meeting program and fiscal standards requirements of State Opioid Response. 

Preferential consideration will be provided to applicants from rural, impoverished areas where clients with opioid use disorder have limited access to medication-assisted treatment.

To be eligible for funding, the center must:

• have a waivered medication-assisted treatment provider on staff — or an existing contractual agreement with waivered medication-assisted treatment provider — to provide medication-assisted treatment for opioid use disorders;
• be committed to treating rural/uninsured patients with opioid use disorder;
• agree to screen all patients for opioid use disorder;
• agree to recommend/provide medication-assisted treatment as a first-line treatment option for patients with moderate to severe opioid use disorder;
• agree to an initial site visit/consultation (either in person or virtual) by State Opioid Response staff;
• agree to ongoingly collect data on medication-assisted treatment for opioid use disorder provision and submit a monthly report to State Opioid Response summarizing this information;
• agree to all practice personnel attending a presentation on stigma related to substance use disorders, provided by State Opioid Response staff;
• agree to submit/present a case study on a patient receiving medication-assisted treatment at the funded center for opioid use disorders at least one time per quarter (every three months) at weekly Project Echo presentations; Project Echo is weekly, online, interactive educational platform to support medication-assisted treatment providers in the treatment of opioid use disorder (Fridays at noon);
• agree to require at least one clinical staff member to participate in at least 50% of weekly Project Echo presentations;
• agree to allow peer recovery support specialists to attend weekly Project Echo presentations;
• agree to complete Government Performance and Results Act and Alcohol/Drug Management Information System data on all patients receiving grant funds at intake to services and discharge and Government Performance and Results Act data at six months post intake;
• agree to have key clinical, administrative, and financial staff attend an initial training on required grant activities regarding treatment provision and documentation, required reports, and billing;
• agree to provide medication-assisted treatment for opioid use disorder patients who receive Medicaid and bill Medicaid for said treatment
• agree to provide access to all State Opioid Response patient records (which must be kept on site) and provide a private space for routine site audits.
• agree to provide in person medication-assisted treatment for opioid use disorder patients at intake and once every six months if treating over telehealth.
• agree to conduct at least one urine drug screen per month for medication-assisted treatment for opioid use disorder patients.
• agree to document in medical record the reason for any medication-assisted treatment for opioid use disorder patient who receives grant-funded services for longer than 90 days.

Failure to comply with above criteria, measured quarterly, could result in loss of funding.

Please note:

• One intake (level 1 or 2) appointment is allowed per opioid use disorder patient for medication-assisted treatment per year.
• One level 1 follow-up appointment is allowed per week per opioid use disorder patient for medication-assisted treatment until stable.*
• One level 2 follow-up appointment is allowed per week per opioid use disorder patient for medication-assisted treatment until stable.*
• One level 3 group therapy appointment is allowed per week per opioid use disorder patient until stable.*

* Justification of clinical need for continuing to meet with patient weekly after four weeks must be documented in patient record in order to receive grant funding for such.

Intake, Level 1

$600 total; up to three hours

• Initial office visit
• Completion of intake forms and Alcohol/Drug Management Information System data collection
• Comprehensive medical exam (MD, APRN, PA)
• Psychosocial assessment (LMSW, LCSW, LAC, LADAC, LPC, LMFT, psychologist, or LPE-1)
• Government Performance and Results Act data collection
• Urine drug screen
• Buprenorphine induction

Intake, Level 2

$400 total; up to two hours

• Initial office visit
• Completion of intake forms
• Comprehensive medical exam (MD, APRN, PA)
• Government Performance and Results Act data collection
• Urine drug screen
• Buprenorphine induction

Follow-Up, Level 1

$200 total; half hour

• Follow-up medical visit (MD, APRN, or PA)
• Urine drug screen

Follow-Up, Level 2

$150 total; 1 hour

• Individual counseling session (LMSW, LCSW, LAC, LADAC, LPC, LMFT, Psychologist, or LPE-1)

Follow-Up, Level 3 — Group Therapy

$300 total; up to 1 hour

• Provided by LMSW, LCSW, LAC, LADAC, LPC, LMFT, Psychologist, or LPE-1
• $25 per medication-assisted treatment for opioid use disorder patient
• No more than 12 patients allowed per group
• Peer Recovery Support Specialist / Peer in Training may not conduct group therapy

• Patient or provider transportation to receive / provide medication-assisted treatment for opioid use disorder (up to 10% of total funding awarded); includes gas cards, bus tokens, mileage ($0.52 per mile), and other expenses as approved, but not cost of vehicle purchase, maintenance, or driver
• Medication for patients receiving MAT for opioid use disorder (up to 25% of total funding awarded)
• Labs (pregnancy tests, as indicated; CBC and Chem-20 at intake only); no reimbursement for drug screening supplies (cost for drug screen included in service bundle)
• Peer Recovery Support Specialist (PRSS) or Peer in Training (PIT)
  • 0.5 FTE (PRSS=$21,750 total; PIT=$18,250) for up to 30 medication-assisted treatments for opioid use disorder patients
  • 1 FTE (PRSS=$43,500 total; PIT=$36,500) for 31-100 medication-assisted treatments for opioid use disorder patients
  • 2 FTE (PRSS=$43,500 X 2 = $87,000 total; PIT=$36,500 X 2 = $73,000 total) for 100-199 medication-assisted treatments for opioid use disorder patients
  • 3 FTE (PRSS=$43,500 X 3 = $130,500 total; PIT=$36,500 X 3 = $109,500 total; for >200 medication-assisted treatments for opioid use disorder patients
• Community Outreach and Education to increase awareness of availability of medication-assisted treatment for opioid use disorder patients who are uninsured or under-insured, particularly in rural, underserved areas
  • $10,000 maximum

• Must conduct ‘means test’ on uninsured patients to demonstrate financial need.
• Maximum income allowed is:
  • $25,000 = Individual
  • $50,000 = Couple
  • $10,000 = per child
• Sliding Scale Evaluation Form
• Financial Communication Form

• Must contact insurance company directly
• Need name, date of birth, address for policy holder
• Must obtain and keep EOB
• Must document contact in patient chart
• It is expected that patients will transition to insurance within 3 months; if not, the reason for continuing to receive grant funded services must be documented in medical record.
• Be skeptical of patients who pay out-of-pocket for medications yet “require grant funds.”

• Have insurance but with a catastrophic deductible (≥$1,000)
• Must bill insurance to reduce deductible and keep EOB on file
• Have patient consider different insurance plan

• All awardees must accept Medicaid as a form of payment
• All awardees must accept all insurances that are available

• Yes, it is allowable to provide treatment via telehealth.
• Initial appointment must be in person.
• Must see patient in person every six months
• At least one urine drug screen must be conducted per month

• Counseling services may be provided by LMSW, LCSW, LAC, LADAC, LPC, LMFT, Psychologist, or LPE-1
• Counseling services must be documented in chart

• Decision up to agency/provider
• Recommend two weeks
• Six month at maximum
• Regardless, information should be in initial treatment agreement
• Discharge note should be placed in patient’s chart to document
• Discharge should be recorded in Alcohol/Drug Management Information System / Government Performance and Results Act (as Client Left Treatment)
• If patient returns after being formally discharged
  • Complete Initial Intake
  • Enter as new admission in Alcohol/Drug Management Information System / Government Performance and Results Act

Required by grant and insurance companies:

• Must document ‘time in’ and ‘time out’ of appointment sessions in chart
• Must check prescription drug monitoring program each visit and document in chart
• Must provide diagnosis of opioid use disorder in chart
• Must include Patient Diagnosis, Insurance, and Financial Information form