Substance Abuse Teatment in Hospital Bed Setting

Q:         When will hospital-based substance abuse services be covered by PAC?

A:         A law passed in 2007 laid out a plan for expanding Medicaid and PAC to adults.  The first phase of this expansion, Medical Assistance for Families provided Medicaid coverage to parents with family incomes below 116% of FPL and is already in effect.  Health coverage for adults without children was supposed to be phased in over several years by expanding the benefits covered by the PAC program until all the services provided under traditional Medicaid were covered.  The final phases of the expansion of benefits covered hospital based services.  Presumably, the PAC substance abuse benefit would include hospital based services when the final phase of the expansion of benefits occurs.  It is not clear when there will be sufficient funding for this to happen.

Q:         What does a hospital-based substance abuse provider do if it is serving a PAC enrolled individual after January 2010?

A:         DHMH developed for PAC patients and programs in HSCRC-regulated space. At this time, hospitals may only bill MCOs for services provided in the emergency room.