Rate Changes Hit Oklahoma's Drug Counselors

Article excerpt

Oklahoma's certified alcohol and drug counselors are facing reimbursement rate changes that industry leaders say are negatively affecting a workforce that has decades of experience to offer.

The Oklahoma Health Care Authority, which administers the state's Medicaid program, and the Oklahoma Department of Mental Health and Substance Abuse Services are phasing in changes to the types of services that certified alcohol and drug counselors (CADCs, a bachelor's degree level position) can bill for, and the new rules mean less money in their pockets. Instead, licensed alcohol and drug counselors (LADCs) - a master's degree level certification - will be the only ones who can bill for services like psychotherapy, treatment plans and assessments, which provide a higher reimbursement.

State leaders say they're making the changes to build a workforce that is better equipped to deal with co-occurring disorders - both mental health and substance abuse problems - and that many states are headed in this direction. Directors of treatment centers and advocates for the industry say they understand the move, but it's forcing them to stop hiring CADCs and is cutting the salaries of counselors who have decades of experience in the field.

"It's drastically changed the hiring practices in our field," said James Patterson, executive director of Specialized Outpatient Services in Oklahoma City. "A lot of people have been let go, even CADCs with long-term experience in addiction counseling. Some agency directors have decided to only hire master's-level LADCs so they have a better ability to provide the whole scope of services."

Patterson said that before the rule changes went into place, his staff was made up of at least 50-percent CADCs. Now that position makes up 20 percent of his personnel, he said. As CADCs have retired or moved on, he hasn't filled their positions, he said, because he can't afford to make up for the reimbursement they've lost. Other treatment center directors have acted more quickly and have let CADCs go, he said.

A CADC has been able to bill for codes that reimburse at a rate of $8 every 15 minutes, Patterson said. When the reimbursement changes are finished rolling out in 2013, that amount will have dropped to $3.89 every 15 minutes, he said.

"Their functions are limited, and it gets harder and harder to make the decision to keep that person," he said.

Oklahoma's law concerning the services that CADCs can provide hasn't changed; they are still legally able to provide therapy and do treatment plans, for example. But because the majority of treatment facilities have contracts with OHCA and ODMHSAS, there are few unaffected by the changes.

Ric Pierson, executive director of the Oklahoma State Board of Licensed Alcohol and Drug Counselors, said some CADCs are going back to school to earn master's degrees, but others who have five to 10 years left in their careers are opting not to spend the time and money. A master's degree also doesn't mean a lot more money, Pierson said. CADCs typically earn $28,000 to $32,000 a year, and LADCs make $32,000 to $40,000, he said.

Statewide, the number of CADCs is dropping, Pierson said. Recent numbers show there are 200 CADCs and 750 LADCs. Two years ago, those numbers were 260 and 600, respectively.

Debbie Spaeth, director of behavioral health at the OHCA, said the rule changes are an effort to treat the patient as a whole individual, a move that's also occurring in the general medical field. …