New Medicaid Policy to Combat Opioid Crisis by Increasing Treatment Access

November 2017 ~

CMS has released a new policy intended to allow states the ability to design demonstration projects toward increased access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD).

According to the press release from CMS, by providing greater flexibility to design programs that improve access to high quality, clinically appropriate treatment, states will be able to pay for a broader spectrum of substance abuse treatments in these projects, including residential treatments that aren’t currently covered by Medicaid without a waiver.

Previously states had been required to build out their entire delivery system for SUD treatment while also meeting rigid CMS standards before Medicaid demonstration approvals could be granted. CMS hopes the new policy will allow states to provide greater treatment options while improving their continuum of care over time.

Accompanying the policy announcement, CMS also announced the immediate approval of both New Jersey and Utah’s demonstration waivers under the new policy.

Under the new policy, New Jersey will provide a comprehensive and coordinated SUD benefit to adults and children while also allowing for the continuum of SUD services provided to Medicaid beneficiaries who reside in residential treatment facilities. The services covered as part of the SUD benefit will include residential treatment, withdrawal management, medication-assisted treatment, peer supports and targeted case management.

Utah’s program is part of a broader delivery system reform effort to address the needs of individuals with SUD, individuals who are chronically homeless, and individuals within the justice system. The demonstration will also expand access to SUD treatment to a more complete continuum of services, including previously excluded residential treatment sites.

In a letter to state Medicaid directors, CMS said the new policy is in response to the current opioid addiction crisis in the United States and will allow states to design projects that fit the needs of their populations and measure the value of these programs to Medicaid recipients. CMS said that state projects under its new program should aim to make notable improvements over the course of five years with goals to increase access, reduce overdose deaths, reduce use of the emergency department or inpatient care for drug addiction treatment and improve care coordination.


Source(s): CMS Press Release; FierceHealthcare; U.S. Department of Health & Human Services; Healthcare Finance;