Medicaid Harm Reduction Services Benefit

The federal Centers for Medicare and Medicaid Services (CMS) approved a NYS State Plan Amendment (SPA) which recognizes the benefit of a harm reduction approach to engaging people who use drugs (PWUD)in health care and prevention services. The SPA permits New York State Medicaid to offer reimbursement for specific Harm Reduction Services. Beginning on July1, 2018, NYS Medicaid members who use or have used any drugs will have access to this new benefit with the availability of Harm Reduction Services (HRS) at authorized Syringe Exchange Programs. These services will be reimbursed by both Medicaid Managed Care and Medicaid fee–for–service systems.

HRS are intended to reduce substance use problems experienced by PWUD, and secondarily by their families, significant others or friends. Through HRS, clients are better able to understand benefits of mental health services, medication assisted treatment and/or treatment for substance use disorder. HRS participation creates opportunities for PWUD to access and remain engaged in health care and treatment services. These harm reduction services are not part of an OASAS drug treatment program. The goal is to improve the lives of PWUD by addressing their substance use and barriers that they may experience in seeking care or supportive services. The success of the client may be incremental improvements in quality of life or defined by the goal(s) the PWUD chooses, not by abstinence. Some individuals may seek abstinence from certain substances as a result of their participation in HRS.

What are Harm Reduction Services?

  • Plan of Care: Includes an intake and assessment, completed jointly by a harm reduction specialist and the PWUD, to identify the individual´s service needs related to their use of substances. Part of the Plan of Care process is to work with the client to identify supportive services that can help improve their quality of life. The harm reduction specialist will work with the client to provide, refer and/or link the individual to any services the client is interested in exploring further. The Plan of Care can be updated with new and revised goals at any time by the client.
  • Individual and/or group counseling: Addresses the individual´s needs and interests.
  • Psycho–educational Support groups: Facilitated discussions about topics relevant to the groups´ lived experiences.
  • Medication management and treatment adherence counseling: Offers support for treatment adherence for Medication Assisted Treatment (including methadone, buprenorphine, Suboxone, or Subutex), HIV, hepatitis C care, mental health medications, or HIV pre–exposure prophylaxis (PrEP).

The Harm Reduction Services benefit is delivered as a client–centered support, meaning clients will work with a harm reduction specialist to identify the combination of services prioritized by the client.

No funds shall be used to carry out the purchase, distribution, or collection of sterile needles or syringes for the hypodermic injection of any illicit drug.

When should I refer a client to the Medicaid Harm Reduction Services benefit?

Harm Reduction Services can help people who use drugs decide what is best for the immediate future regarding their substance use. Consider referring your client to these services at a Syringe Exchange Program if he/she/they:

  • Feel like they are using more drugs than before;
  • Feel like their drug use has become more chaotic;
  • Are concerned about the risk of drug overdose, or they have heard about Fentanyl or other substances potentially contaminating the local drug supply;
  • Feel like they are losing control over their drug use; and/or,
  • Feel like they are in jeopardy of losing their family/children and friends.

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