Reducing Substance Use Disorders

The need to improve how health care is delivered, measured, and experienced is strikingly evident in the substance use disorder delivery system. Nearly 12 percent of adults in Medicaid and 6 percent of adolescents have a Substance Use Disorder (SUD). This population is expected to grow as states continue to adopt Medicaid expansion.  Further, alcohol and substance use diagnoses are two of the top ten reasons for Medicaid hospital readmissions. Many states have found success in implementing policy, program and payment reforms that reduce health care costs and improve the health and health care for Medicaid beneficiaries with SUD.

CMS has been working with states to provide opportunities within Medicaid to enhance existing efforts or take up new efforts to design, deliver and pay for services that improve health outcomes. Over the past several years, CMS has issued a series of bulletins on service coverage, authority options and resources for states to identify and treat SUD under Medicaid:

• In July 2014, CMS, in partnership with CDC, SAMHSA, and NIH released a joint Informational Bulletin to support work with states to offer a broad continuum of SUD services related to Medication Assisted Treatment (MAT).  
• In January 2015, CMS and SAMHSA released a joint Informational Bulletin to address the needs of youth with SUD.
• In July 2015, CMS released a State Medicaid Director Letter: New Service Delivery Opportunities for Individuals with a Substance Use Disorder describing a new opportunity for demonstrations projects approved under Section 1115 of the Social Security Act to develop a full continuum of care for individuals with SUD, including coverage for short-term residential services not otherwise covered by Medicaid.
• In February 2016, CMS released an Informational Bulletin describing emerging best practices for preventing opioid-related harm, including several Medicaid pharmacy benefit management strategies for preventing harms associated with prescription opioid pain medications.

Program Support for State Medicaid Agencies

Through the IAP, states receive technical support designed to accelerate the development and testing of SUD policy, program and payment reforms, including support for MAT, data analytics and strategic planning support when applying for a section 1115 demonstration focused on SUD. Strategies include:

• Payment and health care delivery models: Identify successful service delivery models, benefit strategies, and payment methodologies to promote improved care and better coordination between SUD and health care systems;
• Data analytics: Support states in using data to better understand the needs of the Medicaid populations that have a SUD or that are at-risk of developing a SUD;
• Quality measurement: Collect and test metrics that support states in more accurately measuring improvements in health outcomes for individuals with SUDs;
• Performance Improvement: Assist states in understanding how to integrate elements of improvement as part of their SUD-related projects; and
• State-to-state learning: Share lessons and interventions used by other states.

An overview of specific program support opportunities, including the specific topics of focus, can be found in the IAP SUD factsheet.  

• This High-Intensity Learning Collaborative (HILC) was a year-long program support initiative that started in January 2015 and was designed to support a small number of states in developing the necessary policy and infrastructure changes to improve the care and outcomes for individuals with SUDs. The HILC states are Kentucky, Louisiana, Michigan, Pennsylvania, Texas, and Washington. Following the yearlong collaborative, HILC states are provided ongoing one-on-one support to continue their work. Learn more about the HILC states and their IAP work.
  
  Topics addressed include:
  • Defining Needs and Opportunities Using Data
  • Using Data and Metrics to Track Interventions and Outcomes
  • Quality Metrics Used in the HILC
  • SUD Benefits and the SUD Care Continuum
    • Slides from the June 2015 HILC webinar
  • Care Transitions for Individuals with SUD
    • Slides from the July 2015 HILC webinar
  • At-Risk Populations
  • Developing Payment Strategies for SUD
  • Paying for Value in Behavioral Health
• Targeted Learning Opportunities (TLO) was a 15-part web-based learning series designed to support states in developing strategies for improving their SUD systems. . Participation in TLOs is open to all Medicaid agencies and ended in July 2016. Presentations from the TLOs:
  • Increasing Provider Capacity: Encouraging providers to become Medicaid eligible (March 2015)  
  • Integration of Primary Care and SUD Services (April 2015)
  • Developing a Continua of Care in Rural Environments and other Areas with Low Provider Capacity (May 2015)
  • Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care Settings (June 2015)
  • Integrating SUD into Primary Care Settings (July 2015)
  • Program Integrity for SUD Programs (August 2015)
  • Incorporating SUD into Managed Care Contracts (September 2015)  
  • Merging Data Sources (November 2015)
  • Combating the Opioid Crisis with a Multifaceted Approach (December 2015)   
  • Best Practices and Strategies for Medication-Assisted Treatment (January 2016)
  • Understanding the Continuum of Recovery Housing & Strategies to Aid Supportive Housing (February 2016)
  • SUD Services for Special Populations: Neonatal Abstinence Syndrome (March 2016)  
  • Developing Pay-for-Performance Initiatives (April 2016)
  • CDC Guideline for Prescribing Opioids for Chronic Pain  (May 2016)
  • State of SUD-Related Quality Metrics  (July 2016)
• National Dissemination. IAP has packaged the most prominent themes and topics that surfaced during the few first years of IAP’s SUD work to share them with Medicaid programs and our other key partners and stakeholders across the country through a four-part webinar series and additional publications.
  • Kick Off Webinar
  • Substance Use Disorder Care Continuum (audio, transcript)
  • Linking & Merging Data Sources (audio, transcript)

Additional Information on IAP SUD Activities

In November 2014, we hosted a webinar for states and stakeholders to share our approach to working on SUD treatment and prevention.

States should submit additional questions via e-mail with the subject line "SUD" to the IAP mailbox: MedicaidIAP@cms.hhs.gov. Through the IAP, states can access targeted strategic planning support when applying for a Section 1115 demonstration focused on SUD. Contact Tyler Sadwith (Tyler.Sadwith@cms.hhs.gov) if your state is interested pursuing this opportunity.