The Affordable Care Act, which will extend health care coverage to currently uninsured Americans, will dramatically change how substance use disorders treatment is funded, and the types of services that are reimbursed. Substance abuse treatment providers must start making changes now so they are ready when the Act is implemented in 2014.
Under the new system, funding for many services that previously came primarily from block grants will now come through Medicaid and the private health insurance system. One of the more immediate and practical challenges will be the major changes that will need to be made to billing systems, so that providers can bill for Medicaid-related services. Instead of focusing on filling beds in their programs, providers will have to track and bill by the specific services they provide.
Another major change will be that substance abuse treatment providers will be seen as part of the larger health care system. Both substance abuse treatment providers and primary care providers will need to look for ways to be more integrated and collaborative with one another.
Substance abuse treatment providers will need to become much more familiar with the other medical problems that their clients often face, such as diabetes, high blood pressure and asthma. When they see clients who are exhibiting symptoms of these diseases, they will need to link them back to primary care for evaluation and treatment.
Primary care providers will need to become much more comfortable in giving screening and brief intervention for patients at risk of substance abuse, and in knowing where to refer patients who need further help at all levels of risk. This will mean that substance abuse treatment providers will start seeing a broader spectrum of patients—not just those with full-blown addiction, but also those with milder issues that nonetheless need treatment.
Both primary care providers and substance use disorder service providers will need to better integrate their services for medication-assisted treatment for substance abuse as well, in order to ensure that patients who are receiving medication for opioid or alcohol dependence are also receiving the behavioral services they need.
Health care reform will allow patients to have a much broader choice of providers for substance abuse treatment. They will begin to ask why they should choose Agency X over Agency Y. As a result, substance abuse treatment providers will have to engage and motivate clients to choose them, using data to measure success. They will have to become more visible and competitive in the health care field they will now be a part of, instead of the specialty realm of addiction treatment services.
By starting now to look at billing, integration with health care providers, and how to demonstrate program efficacy to attract patients, substance abuse treatment providers will be better equipped to navigate the new health care system, and to provide their patients with a more comprehensive, better quality of care.
Thomas E. Freese, PhD, is Director of Training for UCLA Integrated Substance Abuse Programs and Principal Investigator and Director of the Pacific Southwest Addiction Technology Transfer Center.
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