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Expanding Access to MAT: The Maine Experience

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  • 1. Expanding Access to MAT: The Maine Experience Linda J. Frazier, RN, CHES, MA Treatment Manager Maine Office of Substance Abuse, DHHS 2009 NIATx Summit & SAAS National Conference Tucson, AZ
  • 2. Maine MAT Partners
    • Acadia Hospital
    • Addiction Resource Center at
    • MidCoast Hospital
    • Aroostook Mental Health Center
    • Maine General Medical Center
    • The City of Portland Health Care for the Homeless FQHC
    • The Maine Alliance for Addiction Recovery
    • The Maine Association of Substance Abuse Programs
    • The Maine Office of Substance Abuse
  • 3. Context of Maine MAT Project
    • 9 OTP Clinics serving 3,518 clients receiving Methadone, capacity is 4,810
    • 5 Original MAT Pilots + 5 New Pilots (6/09)
    • SOTA – State Opiate Treatment Authority
    • History of using Medicaid Funding for treatment; State Plan includes and supports key components
    • OSA seen as authority on Treatment Issues; Solid Relationships across and within state systems and the provider community
  • 4. Key Activities
    • Partnership & Shared Aims – Rapid Cycle PI
    • Surveys, Chart Audit, Focus Groups – Provider Staff & Consumers
    • Implementation of Non Discrimination Language in July 2007 Contracts
    • Implementation of Pay for Performance Contracts July 2007
    • Changes to TDS Data System July 2007 – Added questions on Evidence Based Practices, MAT, Access/Retention
  • 5. RIDER E: PROGRAM REQUIREMENTS (SUBSTANCE ABUSE SERVICES)
    • NON-DISCRIMINATION
    • 13. Providers receiving grant funds from OSA will not discriminate against clients who are using legitimate medications to assist their recovery and will not have policies that allow them to refuse admission to treatment or to discharge clients from treatment based on the use of legitimate addiction medications.
  • 6. Partnership With MAT Agency Pilot Sites
    • Four original AR MAT pilots, 2 added vivitrol sites, LC with these and five additional sites April 2009.
    • ASAM LOC written into licensing regulations 2006.
    • Develop treatment processes & protocols – ID need for medication and access to funds, patients right to have MAT, address internal barriers like staff attitudes.
    • OSA sponsored training to address staff education and identified barriers of prejudice and mis-information about MAT.
    • Site visits in July 2009.
  • 7. Support for MAT Systems Change
    • Continued support for MAT – Coaching, Learning Session Participation
    • State General Funds for MAT
    • Medicaid Reimbursement for Suboxone without Prior Authorization for Addiction Treatment
    • Co-sponsorship & Support for Development of ROSC
    • Education & Training
    • Evaluation of MAT in Addiction Treatment
    • Consulting Medical Director
  • 8.  
  • 9.
    • STOP Selling What You Have
    • START Selling What They Need
    • STOP Talking, START Doing
    • IBM.com/doing/uk
    • Heathrow Airport Billboard
    • October/December 2008
  • 10. Primary Barrier People don’t know what they don’t know
  • 11. Challenges
    • Addiction is a Chronic Health Condition!
    • Information & technology transfer
    • Policy & Regulatory Changes – connecting the dots
    • Preventing Prior Authorization and benefit limitations specific to Medications for Addiction Treatment
    • Funding, Policy, & Professional Silos
    • Using data results to support the above and make the business case for sustaining and expanding access to MAT
  • 12. Results Four original RWJF Advancing Recovery MAT Pilot Sites
  • 13. Percent of Admissions with any MAT
  • 14. Percent of non-methadone admissions with MAT other than methadone
  • 15. Percent of admissions with Buprenorphine
  • 16. Reduced use at discharge: AR agencies
  • 17. Percent Abstinent at Discharge
  • 18. Successful Whole Systems Change Requires ART
    • Trust & Respect
    • Identified Common & Shared AIMS AND Mutual Accountability & Transparency
    • Common Shared Language – Between professional fields and the recovery community
    • Cultural Competency
    • Positive Role Models, Access to Coaching/Recovery Support