States provided guidance in designing treatment options for Opioid Epidemic
Today, the Centers for Medicare & Medicaid Services CMS released guidance aimed at building on our commitment to partner with states to ensure that they have flexibilities and the tools necessary to combat the opioid crisis. This new guidance provides information to states on the tools available to them, describes the types of approaches they can use to combat this crisis, ensures states know what resources are available, and articulates promising practices for addressing the needs of beneficiaries facing opioid addiction. Notably, CMS released an Informational Bulletin that provides states with information they can use when designing approaches to covering critical treatment services for Medicaid eligible infants with Neonatal Abstinence Syndrome (NAS). Additionally, CMS issued a letter to states on how they may best use federal funding to enhance Medicaid technology to combat drug addiction and the opioid crisis.
“The number of American infants born dependent on opioids each day is heartbreaking,” said HHS Secretary Alex Azar. “Today’s announcement reflects the Trump Administration and HHS’s commitment to helping states use Medicaid to support treatment for this condition and other challenges produced by our country’s crisis of opioid addiction. State-level innovation, including in the use of prescription drug monitoring programs and electronic health records, has been and will be a key piece of ending this crisis.”
Addressing Neonatal Abstinence Syndrome
Medicaid services can play a critical role in helping ensure access to treatment for these vulnerable infants who have Neonatal Abstinence Syndrome (NAS). Neonatal Abstinence Syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs primarily among opioid-exposed infants shortly after birth. Experts consider NAS to be an expected and treatable result of women’s prenatal opioid or other substance use, although long term ramifications for the infants are still unknown. As of 2012, there was an average of one infant born with NAS every 25 minutes in the United States and roughly 80 percent of infants treated for NAS receive their care through Medicaid.
“NAS is a significant and rapidly growing public health concern,” said Tim Hill, Acting Director for the Center for Medicaid and CHIP Services. “The number of infants born with a diagnosis of NAS is increasing significantly. This rapid growth is directly related to the opioid crisis facing this country. Through discussions with states, we have recognized their growing challenge in providing treatment services to the expanding number of infants with NAS. We have also recognized that states may not be fully aware of available options under Medicaid that can play a critical role in the care of these infants, as well as the limitations on Medicaid coverage.”
Appropriate treatment using the best evidence-based practices can help these infants withdraw from opioids and other substances and lead healthier lives. NAS treatment may occur not only in hospitals, but also in other settings. In addition to Medicaid-covered treatment for infants, it is important for states to involve mothers and other caregivers in the infant’s care, as appropriate. The use of interventions like swaddling, quiet environments, little stimulation, skin-to-skin contact, and other environmental approaches are critical first line care for these infants.
States may also seek to cover initial or ongoing SUD treatment services for Medicaid-eligible mothers and/or fathers concurrently with NAS treatment services directed at the infant. Services that begin at this critical time, and continue to follow and support the infant and caregiver when the infant returns home, provide the highest likelihood for optimal health status and positive outcomes for infants born with NAS. Medicaid services can play a critical role in helping ensure access to treatment for these vulnerable infants and their families.
Enhancing Medicaid Technology
The opioid technology guidance advises states on which funding authorities may support health information technology efforts that could be used for the prevention and treatment of negative opioid outcomes.
The guidance falls in line with the President’s Commission on Combating Drug Addiction and the Opioid Crisis final report released on November 1, 2017. Specifically, this report singles out telemedicine and prescription monitoring tools as useful in the effort to combat the opioid crisis.
States may access enhanced federal funding to integrate innovative substance abuse treatment in areas facing provider shortages, particularly in rural areas, such as virtual treatment centers or remote counseling, into Medicaid care coordination technologies. The letter also describes how states can draw federal support for shared electronic care plans, which allows patients and providers to view and update a shared care plan describing goals for pain management regimens and counseling, and could complement Medication Assisted Therapy (MAT).
Support for Patient-facing technology in the form of apps and remote monitoring technology is also mentioned as possible state technology investments eligible for funding. Further, states may reduce provider burden by creating a single sign-on interoperability between Electronic Health Records (EHRs) and prescription drug monitoring programs, allowing physicians to e-prescribe in the same platform where electronic health records are held.
Enhanced technologies, which might support the development of public health surveillance, may also be developed that can help strengthen the understanding of the crisis through better public health data and reporting. Most notably, the letter describes how states might draw federal financing to support recommendations from the President’s Commission final report, such as integrating prescription drug monitoring systems data into EHRs and supporting interstate data sharing and electronic prescribing of controlled substances. In addition, the letter shows how states might use systems and funding to support advanced analytics for those looking to leverage data sources to create prediction models of patients at risk for opioid dependency and connect them with appropriate case management.
“Today’s guidance further builds on CMS’ commitment to provide states with the tools and approaches available within the Medicaid program to accelerate states’ ability to respond to the national opioid crisis” said Hill, “By leveraging and improving the technological capabilities of state Medicaid programs, we are providing Medicaid agencies, providers, and patients with the tools they need to improve health outcomes associated with addiction.”
Both sets of guidance compliment a State Medicaid Director (SMD) letter, “Strategies to Address the Opioid Epidemic” (SMD 17-003), issued on November 1, 2017 that outlines state flexibility in addressing the opioid crisis via demonstration projects under section 1115 of the Social Security Act. There are a number of ways technology might support those efforts, but a state need not be participating in a section 1115 demonstration project to take advantage of the enhanced federal funding opportunities described in today’s SMD. To date, CMS has approved SUD-related section 1115 demonstration projects in Louisiana, West Virginia, Indiana, New Jersey, Kentucky, Utah, Illinois, and Vermont to allow these states to improve access to the full spectrum of quality SUD care and treatment for Medicaid beneficiaries.
For more information regarding the Neonatal Abstinence Syndrome Informational Bulletin please visit https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf
For more information on the Medicaid Technology Letter please visit https://www.medicaid.gov/federal-policy-guidance/downloads/smd18006.pdf