Carroll County, Maryland, is poised to serve as a model for treating substance abuse across the state.
The Carroll County Health Department plans to address changes to state funding of outpatient substance abuse services, officials told the Board of Commissioners at a briefing last week.
County Health Officer Ed Singer said the change calls for the involvement of private health care providers, who will then be reimbursed using funds provided by the state. This replaces the current system for funding treatment at the county level, in which a grant is provided to local health departments with a fee-for-service model.
Instead of waiting until January, Carroll County will make the change in July, on pace with a schedule the state had planned on prior to receiving pushback from other local health departments that requested an extension on the time period departments have to make the switch.
Private providers who offer substance abuse services to those with fluctuating insurance coverage will, under the new system, be able to be reimbursed for treatments provided to those who are uninsured or underinsured at the time of service, said Sue Doyle, director of addiction services for the county.
“It’s a good thing in the end,” she said. “It’s a plus for all of us.”
The switch was originally scheduled to take place in July 2015, Singer said, but has been delayed twice after some health departments around the state expressed concern over the change impeding their ability to continue to provide quality treatment to those living in their jurisdiction.
“There’s been a lot of changes going on with our sources of funding in the behavioral health areas over the past few years,” Singer said.
Because of the concerns brought forward by several local health departments, the state will make available a $375,000 grant that will allow the local health departments to continue their current systems from July through December. While many counties around the state are expected to take advantage of the grant, the Carroll County Health Department will opt out of it, Singer said.
Instead of receiving the grant, the county will still get the state money, he said, but it will be integrated into the county’s new fee-for-service system. For those receiving treatment, instead of going to the county Health Department for outpatient services, they will now report to Access Carroll, a nonprofit the county will team with to connect residents to treatment.
“It’s not that we aren’t going to provide the services,” Singer said.
Rather, he said, the county had their plan to deal with the state-mandated change in the works for a while, he said, and is now ready to make the change without needing to prolong the process. To do so, he said, would only delay the inevitable.
Already, Doyle told the commissioners, the Health Department has identified about five private providers ready to begin working as part of the system.
Accepting the grant from the state would only make things more difficult for the county’s eventual transition, Singer said. Already, he said, the department has made the necessary adjustments to staff in order to operate under the new system. If the county accepts the state grant and prolongs its current grant-based system, it would have to either hire temporary staff or contract with a private provider for that six-month period, wasting money that doesn’t need to be spent, he said.
Additionally, he said, the private providers the county plans to incorporate in its fee for service system would be hurt by the delay. The money the state is offering in the six-month window would not be available to use in any way other than extending their current program, he said. Instead of accepting the money, the county would be better off asking the state for some aid in getting local private providers the accreditations needed to operate in the fee for service model.
There are still some details to work out, he said, one of which involves Medicare services being reimbursed at a rate too low to cover costs, but the county is working with the state to finalize the plans.
“We’re going to be doing this six months sooner than everybody else is going to be doing it,” Singer told the board. “We just need to move forward and make this happen.”
“I think the right thing to do at this point is to move forward with this,” Doyle said.