Crowe, Cochran Want To End TennCare Payments For Methadone

SHOULD TENNCARE COVER METHADONE TREATMENT?

Two Northeast Tennessee lawmakers don't think so and are trying to stop
TennCare from paying for it.

Legislation sponsored by state Rep. Jerome Cochran, R-Elizabethton, and
state Sen. Rusty Crowe, R-Johnson City, would prohibit methadone treatment
providers from being reimbursed by the state's $7 billion-plus expanded
Medicaid program on an "as medically necessary" basis.

Cochran said he got the idea for the bill after being told by a probation
officer that methadone treatment for heroin addicts was reimbursed by TennCare.

"I thought that was a little outrageous, so I called TennCare to find out,
and sure enough a couple years ago an administrative law judge ruled the
state had to reimburse people for their methadone treatment," Cochran said.

Cochran said he doesn't have high expectations for passing the bill, which
will get its first hearing in a House subcommittee on Wednesday.

"I suspect it's not going to make it," Cochran said of the bill. "But I
have a big problem with us basically reimbursing people for drug habits."

The state's fiscal impact information for the bill says TennCare currently
spends about $4.1 million annually on methadone treatment - $2.6 million in
federal dollars matched by nearly $1.5 million in state expenses.

TennCare spokeswoman Marilyn Elam pointed out methadone is used for more
than treating drug addiction.

"There's a difference between methadone treatment and the use of methadone
as a painkiller," Elam said. "You have some people in the TennCare
population who would be using methadone not as a treatment for drug
addiction but as a painkiller for their specific medical need."

Elam said if the Cochran-Crowe bill is passed by the General Assembly, the
measure would have to be approved by the federal government's Centers for
Medicare and Medicaid Services.

CMMS spokeswoman Mary Kahn said the federal agency most likely wouldn't
approve prohibiting methadone coverage.

"The Medicaid statute requires states that offer drug benefits to provide
any FDA (Food and Drug Administration) approved drug for medically
necessary purposes," Kahn said.

The Kaiser Commission on Medicaid and the Uninsured said states like
Tennessee have been reluctant to cut some program offerings because any
cost reduction at the state level means a loss of federal matching funds.
The commission noted Medicaid programs must cover things like inpatient and
outpatient hospital services, but drugs fall under optional services.

Gov. Phil Bredesen has made prescription drug limits a centerpiece of his
"last chance" strategy to restrain TennCare's escalating cost, but Elam
said the future of methadone treatment coverage has not yet been addressed.

"We're really not at the stage we can tell you whether or not specific
drugs will or will not be covered other than the two the governor has
brought up - antihistamines and gastric drugs," Elam said. "Methadone is
really a behavioral health drug, and it's something we'll be looking at in
the entire universe of prescription drug benefits and coverages."