Gaps Seen in Mass Addiction Treatments

Massachusetts has a well-developed continuum of care for substance use treatment and recovery services, but behavioral health access is far from equitable because of persistent staffing challenges and inconsistent insurance reimbursement rates, according to a report released by the Association for Behavioral Healthcare.

ABH, a statewide, nonprofit organization representing 82 community-based behavioral healthcare providers, called for bolder policy action and increased investment in programs as the overdose epidemic continues to take lives at a tragic pace in Massachusetts. The report found that large numbers of substance treatment beds are unavailable because of difficulties in recruiting and retaining staff due to inadequate pay and benefits – compensation levels that are dependent on state reimbursement rates.

The report, titled “34 Days and Counting: Waits for SUD Treatment Lengthen Due to Workforce Crisis,” noted that individuals are waiting 34 days for residential rehabilitation settings (longer-term recovery support). Some clients must wait as long as 135 days for admission.

The report also found a 24% job vacancy rate across the substance use disorder treatment system, as nurses, counselors and other providers have left to seek higher-paying opportunities. That has contributed to a decline in the number of licensed treatment beds for uninsured and low-income individuals who are covered by the safety net, compared to individuals who have commercial insurance or can pay privately. Even more staggering, 80% of nursing staff in opioid treatment programs – the only outpatient setting where people can receive methadone treatment for opioid use disorder – have left over a 12-month period.

“As Massachusetts continues to see unacceptably high rates of fatal overdose, we must do more to support and expand the workforce of behavioral healthcare providers who can make a difference in the lives of people with substance use disorder,” said Lydia Conley, ABH President and CEO. “We also have more work to do to hold both public and private insurance payers accountable to ensure that behavioral health treatment parity becomes a reality.”

The ABH report offers a number of recommendations aimed at decreasing stigma and achieving parity among payers, improving workforce recruitment and retention, increasing access, and strengthening service delivery. Specific recommendations include:

· Enhancing the currently inadequate rates set by public payers to a higher benchmark to support fair pay and competitive salaries for the behavioral healthcare workforce.

· Additional investment by the state in student loan repayment programs and other recruitment strategies, particularly for clinicians, prescribers such as psychiatrists, and other providers with specialized training or linguistic competency.

· Creating a state-run behavioral health workforce center of excellence, embedded in higher education, for longer-term planning and development of new strategies.

· Improving health equity by waiving copayments or deductibles for all substance use disorder interventions.

· Expanding access to harm reduction services, including overdose prevention centers.

· Funding and developing programs that are culturally, ethnically and linguistically diverse, and continued funding and procurement of “housing first” models such as low-threshold congregate care and individual housing units.

· Standardizing the payment rates for opioid treatment programs across the insurance system, from public payers such as the Health Connector to private health insurance carriers.

· Supporting payment methods that coordinate and link behavioral health services with primary care, so that individuals can access specialty, patient-centered care when clinically appropriate.

The report analyzed information from a 2022 survey of ABH members about their workforce challenges and recent data related to the substance use disorder care continuum and is available through the following web link: https://www.abhmass.org/newsroom/thirty-four-days-and-counting-waits-fo….

(Image courtesy of CDC)