Commentary: Substance Abuse Treatment Providers: Act Now to Get Ready for Health Care Reform

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.

6 Responses to Commentary: Substance Abuse Treatment Providers: Act Now to Get Ready for Health Care Reform

  1. Luis Lozano | September 30, 2011 at 1:30 pm

    He sure does paint a rosy picture. If you buy that I have a bridge in Brooklyn that I’d like to sell you.

  2. Glenn Major | September 30, 2011 at 2:26 pm

    Excellent article. Let’s hope this doesn’t get blown out of proportion with “expert” consultants selling us on how we must change everyting. In another generation, they were called Carpetbaggers. Many of the good providers have the systems inplace which may only require review and minor changes.

  3. Carlos | October 1, 2011 at 5:56 pm

    If I have anything to do with it, what would be expected (by 2014 is to late)would be real treatment rather than indoctrination. Treatment Staff will need to be a lot more scientific, and really prove that what they do is base in real science, that is systematic, rigurous, frequency based rated. Substance Abuse Mental Health treatment not based on empirical research and the practitioners are allowed to make rubbish up and call it treatment, them blame the patient for the pitiful outcome. We provide them with Bogus Therapist (Beyerstein 1998) I am convince that most brakethought in the treatment of substance abuse mental health will most likely come from the neuroscience and from rigurous quantitative empirical research. I am alarm that the substantial majority of practioners, 72% do not read scientific articles (Beyerstein, Fringe Psychotheraapies; the public at risk)(Butler, 2003)That is where I think that the presure is going to come from. We are going to realy prove with long term follow up and real individual auditing. were they are going to be paid or not for the services or resive referals.

    • Scott Smith | October 4, 2011 at 7:18 pm

      I can only speak for Oregon but addiction and mental health treatment is legislatively mandated to be based on evidence based practices. This means the the practice has been replicated and deemed to be an effective treatment approach based on achieving the same outcomes each time the practice is applied. I do remember the days when this was not so but that is no longer the case. Tax paying citizens can, and should, expect their dollars to be spent on appropriate care and in Oregon treatment providers are required to demonstrate positive outcomes in order to continue being funded via contract and subcontracting.

  4. John B French | October 6, 2011 at 10:22 am

    I truly believe that the “Affordable health care act” will be repealed so not to worryand making changes. I know that to be conservative in this business(substance abuse treatment) is dangerous, but I just can’t sign on to something that will do so much to bankrupt the country and saddle my grand children with debt.

  5. Lisa Berger | April 3, 2014 at 3:01 pm

    The years that have elapsed since this article was written have proven the author absolutely correct. Virtually all funding sources for SUD services now require evidence/science-based prevention and treatment practices. Now, treatment counselors MUST be certified and knowledgeable of these new technologies. And the ACA is profoundly changing the way treatment and recovery services are funded. Thanks to neuroscience, like diabetes, addiction is now understood as a chronic disease and relapse is part of it. As a result, SUD treatment is now part of the healthcare system, rather than a sideline practice. Is everyone who attends an acute treatment program going to stay flawlessly clean and sober? No. No more than a diabetic will never again have high blood sugar. It’s an ongoing disease management process. And I for one am happy that treatment is now more realistic.

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