The Affordable Care Act (ACA) will likely change the rules for many of us in the behavioral health field. Of all the providers facing challenges, those providing residential treatment may face the toughest. The gap between medical models of care and current addiction treatment practices is wide. Hospitals and insurance companies typically prefer a short period of stabilization (typically less than two weeks) followed by some type of outpatient counseling. Contrast that to those in addiction treatment who claim that “28-days isn’t enough” and argue in favor or three to six month treatment programs.
Medical Necessity – Some of us have already learned to work through the maze of prior authorization and justification of medical necessity. Those of us working with the criminal justice system have faced challenges with courts ordering a level of care not supported by the consumers’ needs or available funding. How can you justify a 6 month residential program? What level of disruption is required to justify an extended hospital stay? I realize that for most of us, there is a considerable difference between hospitalization and residential treatment; however, insurance companies will likely not see that difference.
Supply and Demand – I’ve seen consumers spend enough time in jail that they were legitimately no longer appropriate for residential treatment. As the waiting lists for beds grows longer, the criteria for admission gets stricter. We’ve seen a number of pseudo-treatment facilities pop up across Oklahoma attempting to fill the gap that exists between need and availability. These facilities typically house consumers in a supportive living environment and require they work at some type of job, either on or off-site, to support the ongoing operations of the facility. Unfortunately, these facilities are highly unregulated and the level and quality of treatment provided can vary greatly.
Day Treatment or Partial Hospitalization – One potential solution might be some type of day treatment or partial hospitalization. These options could provide about the same amount and duration of therapy as residential treatment facilities without encountering the cost of housing. The challenge for consumers will be finding a supportive living environment. Often, the primary reason for an inpatient referral is the lack of another supportive living environment. Organizations like Oxford House are helping to meet these needs but consumers still face challenges with cost and risk of relapse (which would likely lead to eviction).
What Else? – I’m sure there are other options that work on a small-scale. I would certainly be interested in hearing more about those options and if they are scalable to the needs of the thousands needing more than standard outpatient treatment. Will residential addiction treatment conform to the standards of the insurance industry or will insurance move toward the addiction treatment model? I would love to hear from a variety of professionals from across disciplines about what is currently being done as well as ideas about what could be done going forward.
5 thoughts on “Residential Treatment: Will it survive the Affordable Care Act (ACA)?”
An excellent article. Thank you.
Thank you!
How much treatment is provided in local or state correctional facilities? Maybe it is time to let the various state correctional agencies provide SA treatment. At least it doesn’t have to be short term and is not based on some predetermined insurance carrier’s ideas of what they will pay for.
I think our state and local correctional facilities may be the only longer term drug and alcohol rehabilitation facilities available in the not so distant future with the disappearing RTC’s.
Unfortunately in Oklahoma, our Department of Corrections budgets have been so stretched due to high incarceration rates, many of the programs we provide have been reduced or cut entirely. In my opinion, we need to develop interventions that work as an alternative or diversion to incarceration. Trying to treat the problem at the incarceration level is very expensive and quite often the damage has already been done. Look up information on the Sequential Intercept Model for more about the various “intercept” levels.
Since many high cost private treatment entities continue to encourage use of peer-support services, why not strengthen the skill sets in the recovery arena? I’ve been encouraging local peer-oriented residential recovery agencies to develop a business relationship with the local county public health/substance use agency to supply supportive recovery beds for those in outpatient treatment or who aren’t in treatment at all but are receiving primary health care services. In order to improve the quality of the peer-recovery support services, I have also suggested that administrators of these residential facilities also invest in chronic care health coaching training programs, i.e. the Health Sciences Institute, that strengthens the skills of their peer-employees.
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