Changes in Medicaid Fee-for-Service Benefit Design for Substance Use Disorder Treatment During the Opioid Crisis, 2014 to 2021.
Changes in Medicaid Fee-for-Service Benefit Design for Substance Use Disorder Treatment During the Opioid Crisis, 2014 to 2021.
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DOI：
10.1001/jamahealthforum.2023.2502
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发表时间：
2023-08-04
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医疗补助按服务收费项目中，物质使用障碍治疗的覆盖范围和使用管理政策随着时间推移发生了怎样的变化？
在2014年、2017年和2021年对州医疗补助项目进行的这项调查研究中，物质使用障碍治疗及药物的覆盖范围有所增加，而使用管理政策的使用则随着时间推移有所减少。然而，在一些州，获得更强化治疗服务的障碍仍然存在。
这些研究结果表明，物质使用障碍的就医途径正在改善，但在许多州，覆盖范围的限制仍然存在。
这项调查研究评估了2014年至2022年期间医疗补助按服务收费项目中物质使用障碍治疗的覆盖范围和使用管理政策的变化。
医疗补助是美国物质使用障碍治疗的最大支付方，在应对阿片类药物流行方面起着关键作用。然而，直到2017年，许多州的医疗补助项目仍然没有涵盖临床推荐的全部连续治疗。
为了确定近年来州医疗补助按服务收费（FFS）项目是否扩大了覆盖范围并放宽了对物质使用障碍治疗的获取限制。
在2014年、2017年和2021年，对设有按服务收费项目的州医疗补助项目以及哥伦比亚特区进行了一项关于物质使用障碍治疗覆盖范围的调查。该调查由医疗补助项目主管或了解情况的工作人员完成。数据分析于2022年进行。
针对多种物质使用障碍治疗服务（个体和团体门诊、强化门诊、短期和长期住院、康复支持、住院治疗和戒毒以及门诊戒毒）以及药物（美沙酮、口服和注射用纳曲酮以及丁丙诺啡）计算了以下内容：（1）医疗补助按服务收费项目涵盖这些服务和药物的百分比；（2）医疗补助按服务收费项目使用诸如共付额、事先授权和年度上限等使用管理政策的百分比。
这项研究在2014年和2017年的回复率为92%（51个州中的47个），在2021年为90%（51个州中的46个）。对于2021年这一波，报告的数据是针对38个非仅管理式医疗组织计划的州。在2017年至2021年期间，个体和团体门诊治疗的覆盖范围在各州增加到100%，药物的年度上限使用减少到3%或更低（n≤1）。然而，覆盖范围方面的重要差距仍然存在，特别是对于更强化的服务：10%的医疗补助按服务收费项目（n = 4）不涵盖强化门诊治疗，13%（n = 5）不涵盖短期住院治疗，33%（n = 13）不涵盖长期住院治疗。使用控制措施，如共付额、事先授权和年度上限等有所减少，但仍然普遍存在。
在这项对州医疗补助按服务收费项目的调查研究中，观察到物质使用障碍治疗和药物的覆盖范围随着时间推移有所增加，使用管理政策的使用有所减少。然而，这些研究结果表明，一些州仍然滞后，并对治疗设置了障碍。未来的研究应致力于确定这些障碍对患者的长期影响。
How have coverage and utilization management policies for substance use disorder treatment varied over time for Medicaid fee-for-service programs? In this survey study of state Medicaid programs conducted in 2014, 2017, and 2021, coverage for substance use disorder treatment and medications increased, whereas use of utilization management policies decreased over time. However, barriers to receiving more intensive treatment services still existed in some states. These findings suggest that access to care for substance use disorder is improving, but restrictions on coverage persist in many states. This survey study assesses changes in coverage and utilization management policies for substance use disorder treatment for Medicaid fee-for-service programs between 2014 and 2021. Medicaid is the largest payer of substance use disorder treatment in the US and plays a key role in responding to the opioid epidemic. However, as recently as 2017, many state Medicaid programs still did not cover the full continuum of clinically recommended care. To determine whether state Medicaid fee-for-service (FFS) programs have expanded coverage and loosened restrictions on access to substance use disorder treatment in recent years. In 2014, 2017, and 2021, a survey on coverage for substance use disorder treatment was conducted among state Medicaid programs and the District of Columbia with FFS programs. This survey was completed by Medicaid program directors or knowledgeable staff. Data analysis was performed in 2022. The following were calculated for a variety of substance use disorder treatment services (individual and group outpatient, intensive outpatient, short-term and long-term residential, recovery support, inpatient treatment and detoxification, and outpatient detoxification) and medications (methadone, oral and injectable naltrexone, and buprenorphine): (1) the percentage of Medicaid FFS programs covering these services and medications and (2) the percentage of Medicaid FFS programs using utilization management policies, such as copayments, prior authorizations, and annual maximums. This study had response rates of 92% in 2014 and 2017 (47 of 51 states) and 90% in 2021 (46 of 51 states). For the 2021 wave, data are reported for the 38 non–managed care organization plan-only states. Between 2017 and 2021, coverage of individual and group outpatient treatment increased to 100% of states, and use of annual maximums for medications decreased to 3% or less (n ≤ 1). However, important gaps in coverage persisted, particularly for more intensive services: 10% of Medicaid FFS programs (n = 4) did not cover intensive outpatient treatment, 13% (n = 5) did not cover short-term residential care, and 33% (n = 13) did not cover long-term residential care. Use of utilization controls, such as copays, prior authorizations, and annual maximums, decreased but continued to be widespread. In this survey study of state Medicaid FFS programs, increases in coverage and decreases in use of utilization management policies over time were observed for substance use disorder treatment and medications. However, these findings suggest that some states still lag behind and impose barriers to treatment. Future research should work to identify the long-term ramifications of these barriers for patients.