Paying for methadone treatment in western Mass.

The 22News I-Team requested records from 2009 and 2014 to find out how much MassHealth has paid for methadone.

CHICOPEE, Mass. (WWLP) – In March 2014, former Governor Deval Patrick declared heroin addiction an epidemic and public health crisis, and the heroin problem in Massachusetts continues to grow.

New Governor Charlie Baker is making efforts to follow through on his campaign promise to make addressing this issue a priority. On February 19, Baker announced the first steps of his strategy to confront opioid addiction. This includes the creation of a panel, the Opioid Working Group, charged to formulate a statewide program.

What will be the cost of any new initiative? That will not be determined until the panel comes up with their recommendations.

For addicts seeking to quit, there are many costs associated with treatment. Some are fortunate to have health insurance that covers detox and rehab programs and drugs to help them reduce their dependence on opioids.

Many addicts without the means to pay for drug treatment turn to MassHealth, the Medicaid program in Massachusetts. The 22News I-Team requested the following records from the State Department of Health and Human Services (see the document at the bottom of the page):

  • From January 1, 2009 to December 31, 2009, and January 1, 2014 to November 30, 2014:
    1. The number of people in Hampshire, Franklin, Berkshire, and Hampden counties for whom MassHealth paid for methadone treatment;
    2. The amount MassHealth paid to individual clinics for methadone treatment in the above-referenced counties; and
    3. The amount MassHealth paid for transportation to individual methadone clinics in the above-referenced counties.

This is an explanation of the document provided by the state:

“Note that a provider has at least 90 days from the date of service to submit a claim; more time if there is another insurer with primary responsibility for paying the claim. Therefore, the totals for 2014 include claims paid only as of the date of this report.

The document, entitled ‘H0020 – 2009 & 2014’, is responsive to 1) a. and b., above. That is, it represents all MassHealth fee-for-service claims for procedure code H0020 (methadone) for dates of service in 2009. It also reports all MassHealth fee-for-service claims that have been paid thus far for dates of service in 2014. The county designations represent the location of the billing providers. For 2014, if a provider has multiple locations in the identified counties, the provider will be listed more than once with the numbers associated with the location. For 2009, the data providers overall totals per provider, regardless of the number of locations. Note that MassHealth claims data does not reflect the identification of the medical service associated with the transportation. Accordingly, there is no claims data that responds to request 1) c.”

It was explained to the 22News I-Team that transportation for a specific need or type of appointment is not documented, only that the requested transportation is for medical use.

The data provided shows that in 2009 there were two providers in Hampden County, with a total of 1114 people receiving methadone treatment, 92,897 claims filed totaling $2,597,805.74 paid to two treatment centers.

In five years there has been an increase in methadone treatment in all four counties. The data given for 2014 is up to November 30 and does not include December 2014. 1464 people received treatment, with 101,375 claims and $1,964,940.79 paid to seven treatment centers.

Spectrum Health Systems and the Providence Behavioral Health Hospital are not for profits based in Massachusetts. Habit OPCO and Community Health Care, Inc. are for profit businesses.

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