Substance Use Treatment
The following section features service utilization data of Medicaid beneficiaries in Philadelphia diagnosed in the behavioral health service system as well as medication use data of Medicaid beneficiaries. The treatment data is provided by CBH.
Behavioral Health Services
Behavioral health services include any mental health or substance use disorder (SUD) treatment services. This includes but is not limited to Medications for Opioid Use Disorder (MOUD), outpatient, intensive outpatient, partial hospitalization, case management, halfway house, residential rehabilitation, and detoxification.
Data for 2020-2021 should be interpreted with caution as they were not typical treatment years due to fewer claims being submitted because of the alternate payment arrangement (APA), CBH members may not have not utilized services due to the COVID-19 stay-at-home order or they had difficulties accessing services, as well as provider staff being impacted by COVID-19, thus increasing wait times and clinician availability.
Of note, the decline may be due to a decline in the number of Philadelphians enrolled in Medicaid.
Residential Rehabilitation
Residential rehabilitation services include hospital and non-hospital based, short- and long-term residential rehabilitation and specialty programs such as Journey of Hope and Women with Children. Service includes 24-hour professionally directed evaluation, care, and treatment for individuals with substance use disorder in acute or chronic distress. Residential rehabilitation claims were identified using level of care codes 150.002, 200.002, 200.007, 200.008, 200.009 200.010, 200.011, 200.012, 200.023.
Data for 2020-2021 should be interpreted with caution as they were not typical treatment years due to fewer claims being submitted because of the alternate payment arrangement (APA), CBH members may not have not utilized services due to the COVID-19 stay-at-home order or they had difficulties accessing services, as well as provider staff being impacted by COVID-19, thus increasing wait times and clinician availability.
In 2022, DBHIDS removed prior authorizations for residential rehabilitation (ASAM level 3.5) accessed by Medicaid Beneficiaries. Of note, Philadelphians with private insurance may still need prior authorization to access residential rehab. Of note, the recent increase may be attributed to DBHIDS lifting the smoking ban that was implemented in 2019 , which prohibited all forms of tobacco use at all residential drug and alcohol treatment programs.
Outpatient services are non-residential treatment services providing structured psychotherapy. Services can include assessments for evaluations using the American Society for Addiction Medicine (ASAM) or Pennsylvania Client Placement Criteria (PCPC), testing by a psychologist, therapy with a counselor, psychologist, or psychiatrist; individual, group, couple, or family therapy; medication administration, evaluation, or management; case management, peer support, co-occurring partial hospitalization, and collateral services. For outpatient services, regularly scheduled treatment sessions occur at least three days per week for at most five hours per week. Outpatient service claims were identified using level of care codes 350. – 351., 375.014, and 800.038.
Outpatient Services
Data for 2020-2021 should be interpreted with caution as they were not typical treatment years due to fewer claims being submitted because of the alternate payment arrangement (APA), CBH members may not have not utilized services due to the COVID-19 stay-at-home order or they had difficulties accessing services, as well as provider staff being impacted by COVID-19, thus increasing wait times and clinician availability.
In 2022, DBHIDS also removed prior authorizations for outpatient services (ASAM level 1) allowing more Medicaid beneficiaries to access the service. Of note, Philadelphians with private insurance may still need prior authorization to access outpatient services. The decline may be attributed to the COVID-19 pandemic as many outpatient offices had to switch to telehealth.
Medication for Opioid Use Disorder (MOUD)
The section below reports on individuals who received at least one form of medication indicative of Opioid Use Disorder (OUD) treatment. Medication for Opioid Use Disorder (MOUD) includes methadone maintenance (daily administration or take-home dosage), buprenorphine prescriptions, and naltrexone prescriptions. Prescription claims are provided by Physical Health Managed Care Organizations (PHMCO)- not Community Behavioral Health (CBH), a division of Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS).
In 2019, DBHIDS launched the "Bupe works" campaign to drive Philadelphians contemplating treatment into a single form of medication for Opioid Use Disorder (OUD). Of note, in 2023, the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMSHA) removed the X-waiver, which required prescribers to be registered with the DEA to dispense buprenorphine for OUD. Of note, the increase in buprenorphine among CBH members may be attributed to a DBHIDS sponsored media campaign titled "Bupe Works".
Naloxone
Naloxone is a lifesaving prescription medicine that reverses an opioid overdose. It temporarily blocks the effects of opioids and helps a person start breathing again. The City of Philadelphia is dedicated to distributing naloxone to those at risk of an opioid overdose and those likely to witness opioid overdoses.
In 2018, The City of Philadelphia issued a naloxone availability ordinance, which mandated that every pharmacy in Philadelphia maintain a stock sufficient to fill at least two requests for naloxone. Of note, in 2023, the Food and Drug Administration (FDA) made naloxone available over the counter, but the availability ordinance is still in place. Of note, Naloxone is fulling covered by Pennsylvania Medicaid and there is no co-pay associated with receiving a prescription.