HUNTINGTON — A regional health care organization that offers substance use disorder treatment is suing the state and its contracted managed care organization for failure to enforce federal substance use disorder parity laws.
In January, UniCare, the managed care organization for West Virginia Medicaid, stopped providing reimbursements to OVP Health for urine drug screens performed in OVP Health’s in-house lab. Instead, the screens must be tested at a reference lab to get reimbursements.
OVP offers medication-assisted treatment, or MAT, for substance use disorder. Along with counseling, clients must be screened before receiving their prescription. This helps staff catch relapse and weeds out patients who aren’t there to get better.
The in-house lab has a 24-hour turnaround. Sending screens to an outside lab can take up to four days, OVP officials said. In that time, patients can relapse, overdose and even die.
“It could cost several lives,” said Paul Cowsar, chief operations manager and doctor of nursing practice. “What are those lives worth?”
In October, UniCare sent a letter to providers notifying them of “an amendment” to the provider agreement. The letter, which OVP administration says they did not receive, says the West Virginia Children’s Hospital Insurance Program would be moving under their managed care model. At the end of the letter, it adds that physician office lab code lists have changed. Urine drug screens are no longer included.
OVP’s lab, which is federally certified, operates 24 hours a day, and can return confirmed results within 48 hours at the latest. The new policy would require OVP patients to travel to LabCorp, or another “reference lab,” to be reimbursed. For patients at OVP’s Williamson location, that would mean a trip to Logan, or Pikeville, Kentucky.
“Lack of transportation is our No. 1 barrier,” said Daniel Savage, an MAT patient in Williamson.
When payments ceased in January, OVP reached out to UniCare for clarification and received in return the letter allegedly sent in October. They also met with UniCare leaders, but no solution was reached other than being told to no longer accept UniCare.
OVP has continued to do in-house drug screens despite the lack of reimbursement. More than 360 of OVP’s patients are on UniCare.
Dr. Robert Hess, co-founder of OVP Health and medical director, said the lack of reimbursements is not a sustainable model.
“When I was on the board of St. Mary’s [Medical Center] years ago, I learned a very valuable lesson from the nuns. They had a great saying: ‘No money, no mission,’” Hess said. “If we go on not getting reimbursed for services, something’s gotta give. When we are sitting here with Mylan Pharmaceuticals getting ready to shut down 1,400 jobs — we are a homegrown company. We are all West Virginians. We’ve been part of the revitalization of downtown Huntington. We gave in the last five years about three-quarters of a million dollars to charities and organizations. If we don’t get this rectified, something’s got to stop.”
OVP Health CEO Stacey Shy said OVP and other successful substance use disorder treatment programs like them use all their resources to further expand their reach. He said while the lab is only a portion of their revenue, other organizations rely on that revenue.
“Ultimately, you are going to restrict access for those who we need to support,” Shy said.
State Medicaid guidelines say routine drug testing is not covered unless it is with an extended course of treatment for substance use disorder. State law says drug screens are required when prescribing Suboxone, the main MAT medication.
“Why let an MCO come in and dictate they will cover less than what the state deemed appropriate?” Cowsar said.
Hess said West Virginia should be leading the efforts against substance use disorder. West Virginia Medicaid was in the forefront in changing MAT guidelines as more research became available. Savage, for example, would have been kicked out of the program two-and-a-half years ago under the original guidance because it required patients be phased off Suboxone after one year.
“I am as steady as I could be three years in, and I would have been booted out,” Savage said. “I don’t want my meds taken from me right now.”
Savage said the strict rules, including the urine testing, are why he has succeeded. He said he’s been to other clinics where it’s obvious the screening is either bogus or it’s not done at all. But at OVP, those who aren’t there to get better are weeded out more quickly, which improves the recovery experience for those who are dedicated to getting better.
OVP Health filed the lawsuit Wednesday morning. The Department of Health and Human Resources declined to comment on the pending litigation.