Dr. Chapman highlights opioid treatment challenges amid Medicaid MCO billing issues
September 30, 2025 | Committee on Health, Committees, Legislative, District of Columbia
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The District of Columbia's Committee on Health held a public oversight roundtable on September 30, 2025, focusing on critical issues surrounding healthcare delivery and opioid addiction treatment in the region. Chairperson Christina Henderson led the discussions, which highlighted significant challenges faced by healthcare providers, particularly in the context of Medicaid Managed Care Organizations (MCOs).
One of the primary topics addressed was the need for improved contract language within MCOs to facilitate person-centered, value-based care. Stakeholders emphasized the importance of ensuring that Federally Qualified Health Centers (FQHCs) deliver quality care while maximizing the district's financial investment in these services.
Dr. Chapman, a long-time physician in Washington, D.C., shared his experiences treating patients with opioid addiction, revealing alarming trends in billing practices that have emerged over the past two years. He noted that a significant portion of his patient population is now opioid-dependent, which complicates their treatment due to associated mental health issues and social determinants of health.
Dr. Chapman reported that one MCO had stopped reimbursing for certain critical services, leading to financial strain on his practice. He described the complexities of billing and coding, particularly the practice of "downcoding," which reduces reimbursement rates for complex cases. This practice has made it increasingly difficult for providers to treat high-risk patients effectively.
The roundtable also touched on the broader implications of these billing challenges, as Dr. Chapman highlighted the urgent need for standardized treatment protocols and billing models to support providers in delivering care to opioid-addicted patients. He expressed concern that without adequate compensation and support, fewer healthcare providers would be willing to take on the risks associated with treating this vulnerable population.
The discussions underscored the ongoing opioid crisis in the District of Columbia and the critical need for systemic changes in healthcare delivery to ensure that patients receive the necessary support and treatment. The committee's findings will likely inform future policy recommendations aimed at improving healthcare outcomes for individuals struggling with addiction.
One of the primary topics addressed was the need for improved contract language within MCOs to facilitate person-centered, value-based care. Stakeholders emphasized the importance of ensuring that Federally Qualified Health Centers (FQHCs) deliver quality care while maximizing the district's financial investment in these services.
Dr. Chapman, a long-time physician in Washington, D.C., shared his experiences treating patients with opioid addiction, revealing alarming trends in billing practices that have emerged over the past two years. He noted that a significant portion of his patient population is now opioid-dependent, which complicates their treatment due to associated mental health issues and social determinants of health.
Dr. Chapman reported that one MCO had stopped reimbursing for certain critical services, leading to financial strain on his practice. He described the complexities of billing and coding, particularly the practice of "downcoding," which reduces reimbursement rates for complex cases. This practice has made it increasingly difficult for providers to treat high-risk patients effectively.
The roundtable also touched on the broader implications of these billing challenges, as Dr. Chapman highlighted the urgent need for standardized treatment protocols and billing models to support providers in delivering care to opioid-addicted patients. He expressed concern that without adequate compensation and support, fewer healthcare providers would be willing to take on the risks associated with treating this vulnerable population.
The discussions underscored the ongoing opioid crisis in the District of Columbia and the critical need for systemic changes in healthcare delivery to ensure that patients receive the necessary support and treatment. The committee's findings will likely inform future policy recommendations aimed at improving healthcare outcomes for individuals struggling with addiction.
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