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CMS to Expand Patient Access to Treatment for Substance Abuse

CMS plans to create more flexibility for state Medicaid reimbursement for opioid treatment, improving patient access to treatment for substance abuse.

patient access to treatment

Source: Thinkstock

By Sara Heath

- CMS has announced a new initiative to allow states to design their own programs to expand patient access to treatment for substance abuse and opioid misuse disorders. This move comes as a part of the administration’s efforts to combat the opioid epidemic and President Trump declaring the opioid epidemic a national emergency.

The new policy introduces a Section 1115 waiver that allows states to develop their opioid treatment access programs over time, making it easier for patients to access this type of care. This waiver lets state Medicaid programs reimburse for substance use treatment delivered in residential facilities previously blocked by the Institutions for Mental Disease exclusion.

While states can now implement their programs through a fast-tracked review process, they do need to present CMS with a detailed overview of their substance abuse disorder (SUD) and opioid use treatment plans.

 “This new demonstration policy comes as a direct result of the President’s commitment to address the opioid crisis and ensure states have immediate relief and flexibility,” said CMS Administrator Seema Verma.

“Previous policies ignored the growing urgency of the national opioid epidemic and instead put onerous requirements on states that ultimately prevented individuals from accessing these needed services,” Verma continued. “The Trump Administration’s approach reflects the pressing nature of the issues states are facing on the ground.”

Now, CMS says states can “pay for a fuller continuum of care” for opioid and other drug addiction-related disorders. This includes treatment in residential facilities for which Medicaid was previously unable to pay without full authorization, the agency explained.

Thus far, New Jersey and Utah have demonstration projects under way.

In New Jersey, the state will provide access to opioid and SUD treatment for adult and child patients, including those living in residential treatment facilities. Services include access to residential treatment, withdrawal management, medication-assisted treatment (MAT), peer support groups, and targeted case management.

This streamlined approval process for SUD treatment options was critical for creating state flexibility and expanding patient access to care, according to New Jersey Governor Chris Christie.

“CMS’ approval of New Jersey’s Medicaid Demonstration will remove a decades-old federal barrier so that thousands more New Jerseyans with the disease of addiction will have access to treatment and recovery,” Christie noted in a public statement. “President Trump acknowledged the need for this policy change when he addressed the nation last week and declared a national public health emergency. This is a tremendous step forward in our efforts to aggressively combat the opioid epidemic and save lives.”

In Utah, policymakers have made changes to the broad healthcare delivery system. These changes target assisting individuals with SUD, chronically homeless individuals, and those within the justice system, said Utah Governor Gary R. Hebert.

Utah will be able to expand patient access to opioid use treatment by making broader delivery system reform, Hebert noted.

"I've always maintained the role of the federal government should be to provide states with the flexibility to be innovative in how they operate their Medicaid programs,” Hebert asserted. “Nobody knows how to address the unique challenges we face as a state better than we do.”

“Today's announcement from the Centers for Medicare and Medicaid Services will allow us to address a specific challenge - extending health care coverage, including substance abuse and mental health services, to the homeless population,” he added.

These efforts show promise for expanding patient access to opioid misuse and SUD treatment, which has as of late been lacking, according to a report from the Government Accountability Office (GAO). The report contended that HHS needs to do more to support access to medication-assisted treatment programs.

MAT combines behavioral therapy and use of medications – primarily methadone and buprenorphine – to combat opioid misuse and eventual addiction. The therapy has proven very effective in combating the opioid crisis, GAO said.

HHS has implemented four grants to support better MAT access across the country, as well as relaxed some regulatory requirements that would allow nurse practitioners and physician assistants to prescribe buprenorphine.

Although HHS has successfully carried out those actions, GAO found that the agency has inadequate measures from MAT expansion success. Additionally, HHS has not set a timeline for measuring MAT expansion success.

GAO concluded that HHS must address both of those issues. In doing so, the Administration can make more headway in addressing the opioid crisis.

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