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Gov. Phil Scott has signed a bill that could lead to increased financial backing for the state's addiction-treatment system.

S.225 authorizes the state to develop pilot programs for increasing coverage of the "hub and spoke" medication-assisted treatment program by commercial insurers like Blue Cross and Blue Shield of Vermont.

While commercial insurance covers some aspects of the treatment program, the initiative is supported primarily by Medicaid. And some providers say they are running deficits because they're treating all opioid-addicted patients regardless of their insurance coverage.

The bill garnered support from the state's insurers and from providers seeking more financial stability for an increasingly in-demand service.

"We should be doing everything we can to encourage Vermonters to access this treatment, and S.225 will improve the sustainability of our programs," two University of Vermont Medical Center administrators wrote in testimony on the bill last month.

Vermont's five-year-old medication-assisted treatment program — also called the Care Alliance for Opioid Addiction — uses two kinds of outpatient facilities spread throughout the state.

The "hubs" are treatment centers offering methadone and buprenorphine for those addicted to opioids. The less-intensive "spokes" are medical practices offering buprenorphine.

State Department of Health statistics show that hub and spoke usage continues to grow even as the state has nearly eliminated waiting lists for hub services.

A recent study showed big drops in overdoses and opioid usage among hub and spoke participants. The program has received national recognition.

But the service is expensive, and providers say they've been struggling with a lack of reimbursement for patients not covered by Medicaid. Last month, the Bi-State Primary Care Association said its members are "treating dozens of (commercially insured) and Medicare patients with addiction and not being reimbursed for these services."

"They are treating all of the patients equally because that is the better clinical model. They do this at a cost, however," wrote Georgia Maheras, Bi-State's Vermont public policy director, in a letter to the House Health Care Committee.

Maheras said Bi-State's members "are eager for an all-payer solution and appreciate that this bill helps us get closer to that solution."

Administrators with the Chittenden County Spoke Team at UVM Medical Center said they serve 600 people covered by Medicaid. But they also treat more than 300 people who are uninsured; have commercial insurance; or are covered by Medicare, and that causes funding problems.

"Vermont's program providers have been treating all patients regardless of their insurance coverage, resulting in program deficits," UVM Medical Center's legislative testimony says. "This is not sustainable, as we have seen dramatic increases in the number of patients accessing treatment."

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Contrary to some characterizations during the debate over S.225, commercial insurers like Blue Cross do pay partially for medication-assisted treatment in Vermont.

Sara Teachout, a spokesperson for Blue Cross and Blue Shield, said the insurer currently pays for hub treatment. And in the spokes, Blue Cross "already pays for the visits with professional staff, medication and lab testing," Teachout said.

But other aspects of the program are covered only by Medicaid. These are sometimes referred to as "care-coordination" or "wraparound" services, and they are considered critical for recovery from addiction.

Teachout said examples of care-coordination services not covered by Blue Cross include "help organizing transportation to appointments, making appointments, job counseling, housing assistance, making appointments to see counselors, etc."

So S.225 says the Department of Vermont Health Access should "develop pilot programs in which one or more health insurers contribute funding" in order to provide more reimbursement for medication-assisted treatment.

The bill says insurers should be partners in those pilot programs. And both of Vermont's commercial insurers — MVP, and Blue Cross and Blue Shield — have said they support the effort.

Scott signed S.225 on Monday. The bill is "in line with the governor's commitment to addressing the opioid crisis with a focus on treatment and recovery, in conjunction with prevention and enforcement," said Rebecca Kelley, Scott's communications director.

"This bill supports this work by promoting consistency across insurers," Kelley said.

Teachout said a pilot program is necessary to work through the logistics of expanding insurance coverage for medication-assisted treatment. That includes consideration of the state's "all payer" health care payment reform project and OneCare Vermont, the statewide accountable care organization.

"We wanted it to coordinate with all the other things we're doing with payment reform," Teachout said.

As for how big of a change S.225 could mean for Blue Cross and Blue Shield, Teachout said that's not yet clear. "It just depends on how it gets worked out," she said. "That's why we want to do the pilot."

S.225 also mentions the "potential integration of Medicare funding into opioid treatment programs." Kelley confirmed that talks are underway to bring more federal funding into the state's treatment mix.

"The administration — led by our Agency of Human Services — is continuing discussions with the Centers for Medicare and Medicaid Services to seek Medicare payment for costs associated with (medication-assisted treatment) in spoke practices," she said.


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