Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field
Background: Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expan...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | Drug and Alcohol Dependence Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772724622000622 |
| _version_ | 1798003202884370432 |
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| author | Peggy L. O'Brien Maureen T. Stewart Morgan C. Shields Mackenzie White Joel Dubenitz Judith Dey Norah Mulvaney-Day |
| author_facet | Peggy L. O'Brien Maureen T. Stewart Morgan C. Shields Mackenzie White Joel Dubenitz Judith Dey Norah Mulvaney-Day |
| author_sort | Peggy L. O'Brien |
| collection | DOAJ |
| description | Background: Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. Methods: Using a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. Results: We identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. Conclusions: State regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access. |
| first_indexed | 2024-04-11T12:04:12Z |
| format | Article |
| id | doaj.art-a32d2fa4bdef4b9d88eec34d3cc234a2 |
| institution | Directory Open Access Journal |
| issn | 2772-7246 |
| language | English |
| last_indexed | 2024-04-11T12:04:12Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Drug and Alcohol Dependence Reports |
| spelling | doaj.art-a32d2fa4bdef4b9d88eec34d3cc234a22022-12-22T04:24:45ZengElsevierDrug and Alcohol Dependence Reports2772-72462022-09-014100087Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the fieldPeggy L. O'Brien0Maureen T. Stewart1Morgan C. Shields2Mackenzie White3Joel Dubenitz4Judith Dey5Norah Mulvaney-Day6IBM Watson Health, 75 Binney St, Cambridge, MA, United StatesInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, United States; Corresponding Author: Maureen Stewart, 415 South Street, Waltham, MA, United StatesHeller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA; Washington University in St. Louis, Brown School, 1 Brookings Dr, St. Louis, MO, United States (Present address)IBM Watson Health, 75 Binney St, Cambridge, MA, United StatesOffice of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC, United StatesOffice of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC, United StatesIBM Watson Health, 75 Binney St, Cambridge, MA, United States; Dept. of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA (Present address)Background: Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. Methods: Using a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. Results: We identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. Conclusions: State regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.http://www.sciencedirect.com/science/article/pii/S2772724622000622Residential substance use treatmentMedication for opioid use disorderMedicaid 1115(a) waiverOpioid use disorderBuprenorphine |
| spellingShingle | Peggy L. O'Brien Maureen T. Stewart Morgan C. Shields Mackenzie White Joel Dubenitz Judith Dey Norah Mulvaney-Day Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field Drug and Alcohol Dependence Reports Residential substance use treatment Medication for opioid use disorder Medicaid 1115(a) waiver Opioid use disorder Buprenorphine |
| title | Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field |
| title_full | Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field |
| title_fullStr | Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field |
| title_full_unstemmed | Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field |
| title_short | Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field |
| title_sort | residential treatment and medication treatment for opioid use disorder the role of state medicaid innovations in advancing the field |
| topic | Residential substance use treatment Medication for opioid use disorder Medicaid 1115(a) waiver Opioid use disorder Buprenorphine |
| url | http://www.sciencedirect.com/science/article/pii/S2772724622000622 |
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