How Do Medicaid Agencies Improve Substance Use Treatment Benefits? Lessons from Three States' 1115 Waiver Experiences.
How Do Medicaid Agencies Improve Substance Use Treatment Benefits? Lessons from Three States' 1115 Waiver Experiences.
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DOI：
10.1215/03616878-9716740
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发表时间：
2022-08-01
影响因子：
4.2
通讯作者：
Drainoni, Mari -Lynn
中科院分区：
文献类型：
--
作者：
Crable, Erika;Jones, David K.;Walley, Alexander Y.;Hicks, Jacqueline Milton;Benintendi, Allyn;Drainoni, Mari -Lynn
2015年，医疗保险和医疗补助服务中心（CMS）敦促各州医疗补助计划使用1115个豁免示范来扩大药物使用治疗福利。在扩大福利之前，我们分析了各州决策过程中的四个关键点。我们对早期采纳1115豁免请求的三个州进行了定性的跨案例比较。我们对来自CMS、Medicaid和其他州机构、供应商和管理式医疗机构的关键信息提供者进行了44次访谈。政策制定者扩大了药物使用治疗，以应对“支离破碎”的护理系统和不可持续的资金流。医疗补助工作人员对通过1115豁免或州计划修正案实施新的福利有不同的偏好。1115豁免程序使各州能够提供住宅福利，但州计划修正案使其他服务成为福利的永久组成部分。医疗补助机构依靠组织间网络来确定循证实践。医疗补助工作人员通过关注项目的完整性和药物使用的下游影响，而不是医疗补助受益人的需求，获得了对改革的立法支持。决策过程受到医疗补助机构特征和组织间伙伴关系的影响，而不是联邦行政部门的影响。早期采用医疗补助的州的经验教训为其他考虑类似改革的州医疗补助机构提供了路线图。
In 2015, the Centers for Medicare and Medicaid Services (CMS) urged state Medicaid programs to use 1115 waiver demonstrations to expand substance use treatment benefits. We analyzed four critical points in states’ decision-making processes before expanding benefits. We conducted qualitative cross-case comparison of three states that were early adopters of the 1115 waiver request. We conducted 44 interviews with key informants from CMS, Medicaid, and other state agencies, providers, and managed care organizations. Policy makers expanded substance use treatment in response to “fragmented” care systems and unsustainable funding streams. Medicaid staff had mixed preferences for implementing new benefits via 1115 waivers or state plan amendments. The 1115 waiver process enabled states to provide coverage for residential benefits, but state plan amendments made other services permanent parts of the benefit. Medicaid agencies relied on interorganizational networks to identify evidence-based practices. Medicaid staff secured legislative support for reform by focusing on program integrity concerns and downstream effects of substance use rather than Medicaid beneficiaries’ needs. Decision-making processes were influenced by Medicaid agency characteristics and interorganizational partnerships, not federal executive branch influence. Lessons from early-adopter states provide a road map for other state Medicaid agencies considering similar reform.
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影响因子：
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作者：
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