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Program Description

Program Description

Medication-Assisted Treatment (MAT) Programs are a set of initiatives supported with state and federal funds and operated by the FADAA, a subsidiary of the Florida Behavioral Health Association. These programs fund the costs of medications approved by the Food and Drug Administration (FDA) for the treatment of substance use disorders, specifically, alcohol and opioid use disorders.  The program began in 2015 with funding through the Florida Office of the State Courts Administrator (OSCA) and the Florida Department of Children and Families (DCF) for extended-release injectable naltrexone (Vivitrol®). In 2019, the Florida Legislature expanded the OSCA-funded program to cover all FDA-approved medications for treating substance use disorders.  FADAA’s network of community-based MAT providers, spanning from Pensacola to Key West, provides critical medication to hundreds of adults with substance use disorders in Florida.

 

Populations Served through the MAT Programs

 

MAT Services for Court/Criminal Justice-Involved and At-Risk Adults

Funded by general revenue through a contract with the Florida Office of the State Courts Administrator (OSCA)

FADAA manages two (2) MAT programs with a network of community-based treatment providers across the state to treat individuals 18 years and older who have current or prior involvement with criminal or civil courts and those identified as at-risk for involvement due to current substance use behaviors, peer/family use, or prior histories of criminal or civil court involvement.

Community-based MAT providers in the network conduct biopsychosocial evaluations to diagnose substance use disorder. Medical assessments and lab work provide further confirmation of diagnoses.  Prospective patients must also meet additional criteria to be eligible for medication.  The priority is to serve individuals that have active involvement with one or more of the following court or criminal justice entities:

  • Criminal Court
  • Dependency Court
  • Drug Court
  • DUI Court
  • Mental Health Court
  • Veterans Court
  • Pre-Trial Intervention/Diversion
  • State Probation
  • County Probation

Priority is also given to those who experience:

  • Current Incarceration in county jails
  • Recent Release from state prison*
  • Recent Release from county jails*
  • Marchman Act detention/confinement
  • Baker Act detention/confinement

The program places special emphasis on engaging offenders in the first 120 days following the date of release from incarceration, when they face the highest risk of relapse.

As of August 2024, these programs cover all FDA-approved medications to treat alcohol and opioid use disorders:

  • Buprenorphine, including extended release Sublocade® and Brixadi®
  • Naltrexone, including extended release Vivitrol®
  • Methadone
  • Acamprosate

 

MAT Services for Uninsured and Underinsured Adults

Funded by state and federal funds, and administered through a contract with the Florida Department of Children and Families (DCF)

FADAA manages one (1) MAT program with a network of community-based treatment providers across the state to treat individuals 18 years and older with a substance use disorder who are unable to afford care through existing family resources or third-party payers (e.g., Medicaid, Medicare, and private insurance). The program is supported through general revenue funds that primarily serve those with an alcohol use disorder and federal State Opioid Response (SOR) grant funds to treat eligible adults with an opioid use disorder that may be in combination with other substance use.

To be eligible for SOR-funded services, patients must participate in a formal Government Performance and Results Act (GPRA) interview that gathers information about substance use issues and improvements in recovery/harm reduction, legal involvement, interpersonal relationships, employment, health care utilization, and physical/mental health.  The interviews are conducted at different times during treatment.

As of August 2024, these programs only cover extended-release naltrexone, Vivitrol®.

 

Program Services

 

MAT services provided by FADAA networks are intended to enhance traditional treatment and recovery support services. Providers are strongly encouraged to integrate MAT into their overall continuum of care.  The timing of initial engagement in MAT is crucial to successful follow-through by patients on their prescribed courses of care and overall retention in treatment and recovery support.  The service array under the FADAA MAT programs includes:

Screening – Clinical evaluation and interview with prospective patients to determine the existence of opioid and/or alcohol use disorder; provide education regarding MAT and use of FDA-approved medications; and determine the readiness and willingness to use a MAT protocol in conjunction with counseling and recovery support. Patients can only receive one screening service funded by this program.

The screening should not be the initial contact with individuals. Providers should select potential MAT participants from among existing clientele who are currently engaged in and actively participating in substance abuse counseling and/or recovery support services and demonstrate motivation to follow through on MAT protocols.  Providers must ensure that a minimum of two-thirds (66%) of individuals screened for MAT receive medication services for their alcohol and/or opioid disorders.

Medical Assessment/Lab Work – Involves blood specimen laboratory work to determine prospective patients’ kidney and liver function, and any medical conditions that would preclude the use of medication.  It also includes a pregnancy test for female patients to determine the appropriateness of MAT medications, specifically medications that contain naltrexone.  Initial lab work and physical exam for methadone is conducted prior to induction, pursuant to s. 65D-30.0142, F.A.C.

Physicians review lab work and write orders for medication.  Nursing staff provide overview of selected medication benefits and side effects to patients and patient expectations for MAT participation. Patients can only receive one medical assessment service funded by this program.

Medication Administration – Dose administration and management by medical personnel.

Extended-release injectable naltrexone, buprenorphine, and injectable buprenorphine should be provided as an adjunct to, and in coordination with, behavioral health treatment, including individual and/or group counseling as determined appropriate by the MAT provider. The unit rate for methadone is all-inclusive, and MAT providers must provide required services pursuant to s. 65D-30.0142, F.A.C. and federal rules stipulated by the Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA).

Oral naltrexone may be provided as a short-term MAT option for opioid patients as a precursor to extended-release injectable naltrexone to determine tolerability or potential allergy while the patient is in an inpatient/residential treatment setting where medication compliance can be monitored, or as a short-term transition following a period of successful adherence to the extended-release injectable naltrexone protocol.  Since the FDA has not approved oral naltrexone as a maintenance MAT option for opioid use disorders, FADAA does not approve the use of this medication as the primary maintenance MAT for opioid use disorders in outpatient settings.  Oral naltrexone and acamprosate can be used for extended periods for patients with alcohol use disorders.

Readmission Screening (Court/Criminal Justice-Involved and At-Risk Programs) – Patients that completed or were terminated or transferred from MAT may be readmitted to a provider’s MAT program using an abbreviated screening process to evaluate current substance use status and any changes in key life areas of interpersonal relationships, employment, and court/criminal justice involvement.  Patients must have been out of MAT services for at least 90 days to use this service; patients returning to MAT sooner than 90 days should just be reengaged in their MAT protocol.

Readmission Medical Assessment/Lab Work (Court/Criminal Justice-Involved and At-Risk Programs) – Patients who completed or were terminated or transferred from MAT may be reevaluated by medical staff to update patients’ records to note changes in physical health status and to perform any lab work, urine drug screens, or pregnancy tests, as needed, to determine the appropriateness of reinitiating medication protocols.  Patients must have been out of MAT services for at least 90 days to use this service; patients returning to MAT sooner than 90 days should just be reengaged in their MAT protocol.

Government Performance and Results Act (GPRA) Interviews (Uninsured/Underinsured Program) – Use of federal funding for medication necessitates the completion of the GPRA interviews at intake, six months post-intake, and discharge. Interviews not otherwise paid for by DCF’s managing entities are eligible for payment through FADAA. Patients with opioid use disorders, combination use disorders, or alcohol use disorders with co-morbid stimulant use disorders (being treated under the SOR grant) are required to complete the GPRA interviews for each MAT episode of care.

 

Provider Eligibility

 

The FADAA MAT programs are designed to screen, assess, and administer federal FDA-approved medications to treat alcohol or opioid-addicted individuals who are eligible for publicly funded behavioral health services under section 394.674, Florida Statutes (F.S.). Prospective providers must submit documentation to support their ability to meet the following requirements for the duration a contract:

  1. Licensed under Chapter 397, F.S., or otherwise eligible for a waiver to provide outpatient or residential treatment for substance use disorders.
  2. Licensed under section 397.427, F.S., and Chapter 65D-30.014, Florida Administrative Code (F.A.C.), for the provision of medication-assisted treatment involving methadone, if funded through the contract.
  3. Ability to implement medication receiving storage, and administration procedures that meet FDA-approved prescribing instructions, exemptions and exclusions.
  4. Have medical staff on-site or under agreement licensed by the Florida Department of Health to comply with medical protocols for prescribing, storing, dispensing, administering, and monitoring the use of extended-release injectable naltrexone, oral naltrexone, methadone, buprenorphine, and/or injectable buprenorphine.

Injectable buprenorphine must be administered by the provider’s medical staff and, under no circumstances, are patients allowed to self-administer this medication.

  1. Ability to provide MAT using extended-release injectable naltrexone, oral naltrexone, methadone, buprenorphine, or injectable buprenorphine in combination with counseling and behavioral therapies, to provide a holistic approach to the treatment of substance abuse according to an individual treatment plan.
  2. Have the appropriate care practitioners on staff to:
    • Assess individuals for the appropriate use of FDA-approved medications including the ability to conduct baseline evaluations and required lab work to detect active liver disease and pregnancy.
    • Prescribe the medication.
    • Store the medication.
    • Dispense and administer the medication.
    • Medically monitor the use of FDA-approved medications.
    • Conduct a clinical assessment.
  1. Document that the provider’s Florida-licensed physician has at least one of the following credentials or experience levels:
    • Certification in Addiction Medicine
    • Active in Addiction Medicine Fellowships
    • Psychiatrist with a certificate in Addiction
    • Training in the administration of extended-release injectable naltrexone.
  1. Document that the provider has implemented medication receiving, storage, and administration procedures that meet FDA-approved prescribing instructions, exceptions, and exclusions.  For extended-release injectable naltrexone and injectable buprenorphine, the provider shall maintain the refrigeration needed to store the medications at a temperature between 2-8 degrees Celsius or 36-46 degrees Fahrenheit.
  2. Document that the provider has the capacity to detox or refer patients for detox services and to monitor them or have them monitored for 3-5 days of abstinence (alcohol) and 7-10 days of abstinence (opioids) following detox prior to placing them on extended-release injectable naltrexone.
  3. Under a FADAA contract, the provider may initiate use of methadone or buprenorphine as part of a detoxification process provided patients are transitioned to medication maintenance protocols using these medications.

Evidence of insurance coverage for all provider actions related to the services provided pursuant to a FADAA contract. As a state agency or subdivision, as defined by s. 768.28, F.S., the provider shall provide documentation of insurance coverage pursuant to s. 768.28, F.S., and may be addressed with the submission of a Self-Insured Letter verifying coverage by an ongoing self-insurance program.