Opimri Raograms

Wisconsin .
Department of Health Serv1ces

 



13?01240 (04/2016)

Opioid Treatment Programs:
2016 Report to the Legislature
Background ............................................................................................................................................................................. 3
2013 Wisconsin Act 195 ...................................................................................................................................................... 3
Process to Identify Need Areas ........................................................................................................................................... 3
Areas of Need...................................................................................................................................................................... 4
Request for Proposals ......................................................................................................................................................... 5
Funding ............................................................................................................................................................................... 5
Status Report .......................................................................................................................................................................... 6
Program Goals..................................................................................................................................................................... 6
Program Service Area Map ................................................................................................................................................. 6
Northeast Wisconsin Opioid Treatment Services ............................................................................................................... 7
HOPE Consortium................................................................................................................................................................ 8
NorthLakes Community Clinic ........................................................................................................................................... 10
Observations ......................................................................................................................................................................... 11

This report is a publication of the Wisconsin Department of Health Services, Division of Mental Health and
Substance Abuse Services, Bureau of Prevention Treatment and Recovery. It is published annually in
accordance with Wis. Stat. § 51.422 (3). For more information on opioid treatment services in Wisconsin, visit
dhs.wisconsin.gov/opioids/treatment.htm.
2

 Background
In 2014, the Wisconsin Legislature passed a series of bills aimed at addressing the escalating problem of opiate
use and addiction in the state. These measures have been referred to by lead sponsor and drafter, Rep. John
Nygren, and other supporters as the Heroin, Opiate Prevention and Education (HOPE) Agenda. The focus was
on nonmedical use of narcotic painkillers, heroin use, overdose emergencies and deaths, and treatment failures
with traditional drug counseling programs.

2013 Wisconsin Act 195
Enacted in 2014, 2013 Wisconsin Act 195 (Wis. Stat. § 51.422, Opioid Treatment Programs) called for the
creation of two or three new regional comprehensive opioid treatment programs in rural and underserved, highneed areas of the state. It directed the Department of Health Services to request proposals for programs offering
the following services:
• Assessment to determine what type of treatment is needed.
• Medication-assisted treatment (MAT), including medications that have been approved by the Food and
Drug Administration.
 Buprenorphine (Subutex®, Suboxone®) – Prevents opioid withdrawal symptoms
 Naltrexone (Depade®, ReVia®, Vivitrol®) – Blocks opioids from acting on the brain
• Abstinence-based treatment.
• Licensed, 24-hour residential services.
• Outpatient counseling.
• Handoffs to county-authorized or private continuing care for individuals who have completed treatment
under the program.
These programs may not offer methadone treatment.

Process to Identify Need Areas
To develop the request for proposals, the Department of Health Services utilized a three-step process to
determine which areas of the state qualified as rural and underserved, high-need regions. All Wisconsin
counties were included in this analysis.
• Rural: Counties with 50 percent or more population living in rural areas were classified as rural. This
analysis was based on data from a U.S. Census Bureau report, Wisconsin 2010: Population and Housing
Unit Count.
• Underserved: Counties were identified as underserved if more than 75 percent of its territory fell outside
the service area of one of the opioid treatment programs operating in 2014. This analysis did not include the
opioid treatment program located in Eau Claire because this program does not accept Medicaid patients.
• High-Need: Counties were scored based on their ranking in each of these five opiate use-related indicators
over three years.
 Opiate/cocaine arrests per 10,000 population
 Opiate deaths per 10,000 population
 Opiate hospital admissions per 10,000 population
 Opiate emergency room visits per 10,000 population
 Narcotic prescriptions dispensed per 10,000 population

3

 Areas of Need
Upon completion of the needs analysis in 2014, the Department of Health Services identified four regions that
met the criteria listed in Wis. Stat. § 51.422 (1).
• Central: Adams, Juneau, Marquette, and Richland counties
• North Central: Forest, Iron, Oneida, Price, and Vilas counties
• Northeastern: Florence, Marinette, and Menominee counties
• Northwestern: Ashland, Bayfield, Burnett, Douglas, Sawyer, and Washburn counties
To determine the areas of greatest need, client volume in each county listed above was reviewed to determine if
there would be a sufficient number of admissions to sustain an opioid treatment program. 1

County

Adams
Ashland
Bayfield
Burnett
Douglas
Florence
Forest/Oneida/Vilas
Iron
Juneau
Marinette
Marquette
Menominee
Price
Richland
Sawyer
Washburn

Medicaid-Funded Admissions
2010

2011

2012

32
<25
<25
<25
48
<25
65
<25
<25
100
<25
<25
<25
<25
<25
<25

25
37
<25
<25
48
<25
78
<25
37
87
<25
<25
<25
<25
<25
<25

36
52
25
<25
48
<25
114
<25
<25
73
<25
<25
<25
29
36
<25

3-Year
Total
93
108
51
45
144
34
257
<25
96
260
52
36
28
60
61
37

1

Wisconsin County Authorized
Admissions
2010
<25
<25
<25
<25
43
<25
80
<25
<25
34
<25
<25
<25
<25
<25
<25

2011
<25
<25
<25
<25
32
<25
78
<25
<25
30
<25
<25
<25
<25
<25
<25

2012
<25
<25
<25
<25
31
<25
104
<25
<25
43
<25
0
<25
<25
<25
<25

3-Year
Total
30
<25
<25
<25
106
<25
262
<25
41
107
37
<25
<25
<25
<25
<25

Number
in Need of
Treatment
310
300
169
151
631
136
1309
96
346
926
225
103
96
204
192
129

There are several assumptions built into the table’s calculation of the number in need of treatment. A report from The
Management Group, Madison, showed that 6 percent of Human Services Reporting System (HSRS) and Medicaid
admissions are duplicates. The Wisconsin Mental Health Substance Abuse Needs Assessment report showed that
46 percent of all Wisconsin persons receiving treatment do not appear in the Medicaid or HSRS databases, but rather are
reported in commercial insurance databases. Furthermore, only 23 percent of those persons who need treatment actually
obtain treatment.
4

 County Clusters
Northwestern Wisconsin
Douglas County
Bayfield
Washburn
Burnett
Ashland
Total
Northeastern Wisconsin
Marinette
Florence
Menominee
Total

Estimated Number
of Clients in Need
of Treatment

County Clusters

North Central Wisconsin
631 Forest/Vilas/Oneida
169 Iron
129 Price
151
300
1,380 Total
Central Wisconsin
Juneau
Adams
Marquette
Richland
Total

926
136
103
1,165

Estimated Number
of Clients in Need
of Treatment
1309
96
96
1,501
346
310
225
204
1,085

The legislation authorizing the establishment of this grant program called for up to three opioid treatment
programs. Due to the availability of funds and the mandate to focus on the areas of greatest need, the Central
Region (Juneau, Adams, Marquette, and Richland counties) was excluded from the request for proposals.

Request for Proposals
A request for proposals for the Northeastern, North Central, and Northwestern regions was issued in January
2015 to solicit applications from any nonprofit agency, county agency, or tribal agency. Four applications were
received by the deadline in March 2015. The three with the highest scores were chosen to proceed with
contracting.
• Northeastern Region: Northeast Wisconsin Opioid Treatment Services
• North Central Region: HOPE Consortium
• Northwestern Region: NorthLakes Community Clinic
Contracts were executed with these organizations with a start date of June 1, 2015.

Funding
In 2015, total grant funding in the amount of $2,064,000 was available from the time of the grant award, June 1,
through the end of the year, December 31. Each program received $688,000.
As of January 1, 2016, the annual amount granted to each program is $672,000.
Four annual calendar year renewals are available upon satisfactory performance and contract compliance.

5

 Status Report
The development and implementation of a wide-ranging opioid treatment program takes time. In the last year,
the grantees have been engaged in organizing their collaborations with community partners; securing space to
provide services; developing administrative and clinical policies and procedures; recruiting staff; identifying
service providers; contracting for services; training; obtaining federal and state approvals, licenses, and
certifications for newly established services; and building community awareness of their services.

Program Goals
The opioid treatment programs funded under Wis. Stat. § 51.422 have four goals.
• Goal 1: To provide regional approved and effective stabilization and residential detoxification services and
treatment and support services for individuals addicted to opioids (heroin or other opioid
substances) in rural, underserved, and high-need areas of Wisconsin.
• Goal 2: To increase retention in opioid treatment services, improve quality of life, and reduce relapse or
return to using illicit opioids.
• Goal 3: To reduce the number of deaths associated with opioid use in the areas served by the program.
• Goal 4: To reach out to untreated opioid-addicted women of childbearing age, offer priority admission to
services for pregnant women, and reduce the number of infants who are affected by opioids.
Program outcome measures and procedures for collecting the data have been established. Outcome data will be
included in future editions of this report.

Program Service Area Map
NorthLakes Community Clinic

HOPE Consortium

Northeast Wisconsin Opioid Treatment Services

6

 Northeast Wisconsin Opioid Treatment Services
Region: Northeastern
Counties: Florence, Marinette, Menominee, Oconto
Tribes: Menominee
Libertas of Marinette
1409 Cleveland Avenue
Marinette, WI 54143
715-735-0095
This collaboration grew out of a discussion between Marinette County Drug Court Judge James Morrison,
Libertas, and Prevea Health. Judge Morrison observed that some of the grant program’s elements were already
in place and that the grant funds could be used to incorporate important missing elements, serve more people,
and improve the continuity and quality of services so that patients would have a seamless experience that would
make successful treatment and recovery more attainable.
Services are provided at locations managed by Libertas, Prevea Health, and/or Hospital Sisters Health System.
This project has served 25 individuals since the start of services in October 2015.
Prior to the start of services, the collaborative established policies and procedures to thwart diversion of
medications to illicit street use, an important strategy to prevent opioid deaths. Additionally, program leaders
informed primary care and obstetrics and gynecology providers of the services offered by the collaborative as
part of their outreach efforts to untreated opioid-addicted women of childbearing age.
Goals for 2016 include:
• Build relationships with county and tribal agencies in the region.
• Recruit a case manager to obtain baseline data on opioid deaths in the region.
• Obtain access across the collaborative to an electronic health record and practice management system to
enable filing claims to Medicaid and other third-party payers.

7

 HOPE Consortium
Region: North Central
Counties: Forest, Iron, Oneida, Price, Vilas
Tribes: Forest County Potawatomi, Lac du Flambeau Chippewa, Sokaogon Chippewa
Forest County Potawatomi AODA Services
5519 Wej Mo Gek Court
Crandon, WI 54520
715-478-4370

Options Treatment Programs/Koinonia
1991 East Winnebago Street
Rhinelander, WI 54501
715-362-5745

Iron County Human Services
300 Taconite Street
Hurley, WI 54534
715-561-3636

Price County Health and Human Services
104 South Eyder Avenue
Phillips, WI 54555
715-339-2158

Lac du Flambeau Chippewa Family Resource
Center
533 Peace Pipe Road
Lac du Flambeau, WI 54538
715-588-1511

Sokaogon Chippewa Community Health Clinic
3144 VanZile Road
Crandon, WI 54520
715-478-5180
The Human Service Center
705 East Timber Drive
Rhinelander, WI 54501
715-369-2215

Marshfield Clinic
9601 Townline Road
Minocqua, WI 54548
715-358-1814
Ministry Behavioral Health
1020 Kabel Avenue
Rhinelander, WI 54501
715-361-4700

This collaboration grew out of discussions between Marshfield Clinic and other health care leaders in the North
Central Region. It is a public-private partnership among the region’s county agencies, tribes, addiction service
providers, and medical providers. County sheriffs also support the program.
The sites listed above provide medication-assisted treatment. This project has served 20 individuals since the
start of services in October 2015.
The consortium is establishing policies and procedures for services for women of childbearing age. Currently,
all women are asked about their pregnancy status during the initial appointment. Pregnant women are given
priority admission.
Consortium leaders serve as advocates for medication-assisted treatment across the region. For example, the
Lac du Flambeau Tribe was poised to ban buprenorphine for any of its members. Through the consortium’s
efforts to provide education and discussions with tribal leadership, the ban on buprenorphine was averted.

8

 All consortium partners have the capacity to bill patient insurance and Medicaid for services provided. The
Minocqua service location allows clients with insurance issues or no insurance to access treatment the same day
they inquire about services. This approach will be expanded to other locations.
Goals for 2016 include:
• Execute formal agreements with all treatment providers in the consortium.
• Establish a 24-hour phone line for clients seeking treatment.
• Inform hospitals and providers of obstetrics and gynecology services of the consortium’s services.
• Establish anti-diversion programming, including drug testing.
• Develop an approach to accurately count opioid-related deaths.
• Deploy a database system across the consortium to track clients receiving services.
• Address the issue of billing Medicaid for services provided by care coordinators attached to a non-county
entity.

9

 NorthLakes Community Clinic
Region: Northeastern
Counties: Ashland, Bayfield, Burnett, Douglas, Sawyer, Washburn
Tribes: Bad River, Lac Courte Oreilles, Red Cliff
Ashland Vaughn Clinic
502 Main Street West, Suite 305
Ashland, WI 54806
715-682-5207
NorthLakes Community Clinic has a long history of providing medical care to this region. Agency leaders
became interested in this program following discussions with other medical organizations and consultants and
its acquisition of the Ashland Area Council on Alcoholism and Other Drug Abuse.
To date, services are being provided in Ashland and Bayfield counties at NorthLakes Community Clinic
locations in Ashland and Iron River. This project has served 29 individuals since the start of services in October
2015.
Anti-diversion policies and procedures have been implemented. This effort involves drug testing, client
treatment contracts, verifying prescriptions with the Wisconsin Prescription Drug Monitoring Program, and
pill/strip counts.
Pregnant women are given priority admission. At this time, the clinic provides care coordination with obstetrics
providers in Ashland and Bayfield counties.
The clinics have a sliding scale fee policy so that no client in need of services is refused based upon their ability
to pay for services. All clinics have the capacity to bill Medicaid and private insurance.
Goals for 2016 include:
• Complete an assessment of service needs in the region.
• Begin services in Sawyer County.
• Convene a stakeholders group to establish a clear definition of an opioid-related death and collect baseline
data.
• Explore and develop policies and practices on the provision of services for pregnant and parent women.
• Establish relationships with Bad River, Lac Courte Oreilles, and Red Cliff tribal communities.

10

 Observations
It is clear that undertaking the provision of opioid treatment services in these regions would not have been
possible without the support provided under Wis. Stat. § 51.422. This support makes it possible for individuals
to receive treatment close to home while retaining jobs, having a stable living environment, and maintaining
important relationships that are essential for effective treatment and long-term recovery.
The Division of Mental Health and Substance Abuse Services, Bureau of Prevention Treatment and Recovery
oversees this program for the Department of Health Services. During site visits and program meetings with the
grantees in the last year, staff have observed a similar set of challenges facing each project.
Perception of opioid treatment with medications. Abstinence-based treatment approaches are long-standing
traditions in many of the areas served by these programs. Awareness, establishing effective anti-drug diversion
policies and procedures, and putting drug testing protocols in place for patients have increased the acceptability
of medication-assisted treatment in these regions, but more work needs to be done to shift perspectives on
medication-assisted treatment.
Significant shortages of clinical staff in rural areas. All grantees have faced challenges recruiting staff.
Federal requirement regarding buprenorphine. Under federal law, if the number of active patients for a
prescriber exceeds 30 in the first year or 100 in the second year and subsequent year of practice, either
additional prescribers will need to be recruited, or the service provider must seek special certification for
narcotic treatment. Grantees are aware of this law and will address this issue if their caseload projections and
availability of prescribers warrant it.
Large service territories. It is important that clients have the opportunity to meet their entire treatment team at
one location because of the distances some clients must travel to receive services.

11