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State panel OKs Ohio Medicaid’s plan for drug treatment workers with convictions

September 18, 2018

State panel OKs Ohio Medicaid’s plan for drug treatment workers with convictions

COLUMBUS, Ohio - A number of recovering addicts employed in drug and alcohol treatment centers could lose their jobs under new Ohio Medicaid rules that consider past criminal convictions. 

The rules require the ex-addicts -- and everyone else who provides behavioral health and addiction services -- to register as Medicaid providers for billing purposes. They must undergo criminal background checks -- and if the screenings show they’ve been convicted of crimes, the providers may not be able to offer services, or they may have to wait years before they can.

Ohio’s mental health community is concerned about the rules -- which the majority on a state panel approved Monday. The mental health community argued recovering addicts who provide so-called “peer recovery services” offer other addicts real-life experience and the hope for change. Studies have shown peer recovery can be effective.

Those who work in mental health and addiction note Ohio is in the throes of an opioid epidemic, and there are not enough providers right now. 

The rules are the result of changes in Ohio Medicaid billing that went into effect July 1.

Prior to July 1, the workers’ employers usually billed for their services. But this summer, managed care organizations began reimbursing drug treatment centers, and the state is requiring all providers to get a Medicaid billing number to make billing more precise and to allow the department to better track treatment trends and successes.

“We recognized there were going to be employers out there who had individuals who were not going to be eligible to be registered with Medicaid,” Ohio Medicaid Assistant Director Jim Tassie told cleveland.com in a July interview.

But Tassie said Ohio Medicaid had no idea how many peer recovery providers there were.

“It’s because the provider community had not shared this with us,” he said. “We had not realized the magnitude of the problem until quite recently.”

No one knows the number of addicts who could be affected. About 132,000 people are providers in Ohio Medicaid, Tassie told a committee that reviews state agency rules. 

Tassie argued it is necessary to consider people’s criminal backgrounds for patient safety and wise stewardship of taxpayer money. Ohio Medicaid considers criminal backgrounds for people who offer home health services, he said. 

Restrictions  

Ohio Medicaid has considered dozens of crimes, including:

Murder, rape, kidnapping, patient abuse and neglect and Medicaid fraud: People convicted of these crimes can never become Medicaid providers.Aggravated robbery and burglary, identity fraud and drug trafficking: People convicted of these crimes would have to wait 10 years after completion of their sentences to become eligible to be Medicaid providers.Prostitution, breaking and entering, theft, passing bad checks: People would have to wait five years after their sentence is complete to apply to be a Medicaid provider.Possession of drugs and drug paraphernalia: There would be no waiting period for people convicted of these crimes.

Ohio Medicaid’s rule would allow people to get around the waiting period if they can secure a certificate for qualified employment, which is a process in Ohio in which people with felony convictions can ask judges for relief from the mandatory restrictions of where they can work. However, providers testified Monday the process is expensive and is confusing and many didn’t even know it existed. 

Lawmaker questions

State Rep. Dan Ramos, a Lorain Democrat, argued during Monday’s meeting that the waiting periods for some crimes were inappropriate, considering the convicted were addicted to drugs. 

“I’m curious about this five-year exclusionary period,” he said. “Because I guess my question is, a number of those things could be considered – like theft – as drug-seeking behavior. I can even see prostitution. Some of the victims of human trafficking (have said) it was something they do to get drug money.”

“I don’t think it’s fair to suggest one group of individuals is (more) susceptible (to re-offend) than another group,” Tassie said. 

Lawmakers paused the Monday committee meeting to discuss the rule in private with other committee members of their respective political parties -- which is unusual. Testimony over the rule lasted for hours. 

At treatment centers

Thomas Stuber, CEO of Lorain County Alcohol and Drug Abuse Services, which operates in Lorain and Medina counties and soon in Erie County, said two of his employees were denied Medicaid provider numbers in August. They had their applications in before July 1. That means the agency will not get $20,000 from Medicaid, he said. 

“I’ve been in the field of addiction treatment for 38 years and it has become clear to me over that period of time that the majority of those who enter the field do so as a result of ‘lived experience,’” said Stuber, who is also president of the Ohio Alliance of Recovery Providers, which has 35 treatment agencies across Ohio.

That lived experience, which sometimes includes criminal activity to support their addiction or as a result of it. Yet their experience is “what makes them so effective in helping others with addictive disorders.”

The employees were put on partial leave – they were removed from clinical care but do other work for the agency. About 30 clients have not been able to receive services because of this, Stuber said.

“We know that individuals who are addicted and not receiving services will continue their drug use and continue the destructive behaviors that go with it,” he said.

Tassie said that employees who are denied provider status could temporarily get provider numbers until they could get court OK to work, or until October 2019 -- when Ohio Medicaid will revisit the rule and potentially change it. 

Many drug treatment centers said they were having trouble getting through to the department to get provider numbers. 

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