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Detoxification pro grams in particular antimicrobial plastic buy 250mg ampicillin visa, as opposed to some other areas of substance abuse treatment antibiotics for uti price cheap 500mg ampicillin visa, may be attractive candidates for private financing because of their potential to serve privately insured and selfpay patients antimicrobial humidifier ampicillin 250 mg for sale. However antibiotic resistance articles cheap ampicillin 500 mg without prescription, acceptance of private capital usually carries with it requirements for rapid growth in rev Funding Streams and Other Resources in the Substance Abuse Treatment Environment Substance abuse treatment and detoxification services in the United States are financed through a diverse mix of public and private sources, with substantially more being spent by the public sector. Public sources account for 64 percent of all substance abuse treat ment spending, a much higher percentage than public expenditure for the rest of health care (Coffey et al. The existence of diverse funding streams presents both man agement challenges and opportunities for pro gram independence and stability. Diversification of funding sources should be a major goal for detoxification programs. Because of this, any new or existing detoxifi cation program requires a fairly sophisticated management and accounting system to meet Financing and Organizational Issues 147 enues and profitability that may be difficult to meet and may limit operational flexibility, at least in the short term. In the longer term, successful detoxification programs may be able to generate profits. Funding streams associated with public and private health insurance often provide bene fits to covered individuals that vary according to whether or not the services are facility based and accord ing to the level or setting of care. The Substance Complexity arises because coverage Abuse Prevention and reimbursement depend both on and Treatment whether a service is considered to be a Block Grant medical service or a substance abuse program is the treatment service and whether a ser cornerstone of vice is facility based. Any episode of detoxification may be denied reimbursement under a plan if medi cal necessity is not demonstrated to the satis faction of the plan or if the service is provid ed at a higher level of care than is judged medically necessary. It is important to decide whether to make a new detoxification program hospitalbased, facilitybased, or officebased. Services that are considered hospital or facilitybased, like those in hospital outpatient departments, often are eligible for higher payment rates than officebased services to reflect their greater capital and other overhead costs. Similarly, hospital inpatient services often are reimbursed at a higher payment rate than outpatient services, but medical necessity determinations also require patients to need more intensive services. Sometimes, patient copayments or coinsurance rates may be higher for officebased services than facility based services. Detoxification programs that are parts of hos pitals, affiliated with a hospital, or consid ered as a licensed facility themselves may be eligible for higher rates of reimbursement than are those that are considered to be out patient programs with no facility license. However, utilization management criteria to authorize payment for admission to and con tinued stay in a hospital inpatient setting require a significantly greater severity of patient diagnosis than do criteria for admis sion and continued stay in a freestanding or outpatient program. On the other hand, often there are high barriers to obtaining a facility license to open a freestanding 24hour facility or licensed outpatient detoxification facility. Programs that are part of or affiliated with hospitals also must contend with overhead cost allocations from the hospital as well as with oversight from hospital administrators who may know little about substance abuse treatment or detoxification. In addition, some health insurance plans actually exclude cov erage for hospitalbased or freestanding facil itybased detoxification programs and others may subject admissions to such programs to Chapter 6 Federal funding for substance Many public and private benefit plans still classify abuse treatment substance abuse detoxification as a and detoxification medical rather than a substance abuse programs. In general, and especially for employerbased coverage, benefits under a medical plan are provided at higher reimbursement rates with fewer limits and restrictions than are benefits for substance abuse treatment (Merrick et al. Requirements for outofpocket pay ments by those covered under these plans typically are lower under the medical portion of a plan than under the substance abuse treatment portion. Program planners should consider carefully all alternatives; decisions concerning affilia tion with a hospital or pursuit of a facility license have farreaching financial and politi cal ramifications and should be made with as much information as possible. Following is a discussion of the key funding streams and resources that are available for programs providing detoxification services. Services may be paid for through grants, contracts, feeforservice, and/or managed care arrangements. Treatment purchasing systems may evolve over time; managed care arrangements and require ments are increasingly common. Each program should check to see if the clients it intends to serve are eligible for block grant funding, either for setasides or for other funds. Each State maintains its own criteria for eligibility and the criteria and definitions vary greatly among States. Multistate providers will need to check specifically in each State in which they operate. Medicaid is being used by many States as a vehicle for experimentation with public sector managed care in an effort to expand medical coverage to the uninsured.
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