Effects of Medicaid IMD SUD waiver on access to addiction treatment

医疗补助 IMD SUD 豁免对获得成瘾治疗的影响

• 批准号: 10726979
• 负责人: Tamara Janelle Beetham
• 金额: $ 4.63万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10726979
• 关键词: Accounting; Address; Adoption; Ambulatory Care; Buprenorphine; Caring; Clinical; Complex; Directories; Disease; Drug abuse; Epidemic; Evaluation; Exclusion; Face; Goals; Health; Health Services; Heterogeneity; Improve Access; Incentives; Individual; Industry; Inpatients; Institution; Insurance Carriers; Interdisciplinary Health Team; Knowledge; Life; Maintenance; Maintenance Therapy; Measures; Medicaid; Methodology; Minority; Modeling; Opioid; Outcome; Outpatients; Overdose; Overdose reduction; Patients; Persons; Pharmaceutical Preparations; Philosophy; Physicians; Policies; Policy Maker; Positioning Attribute; Probability; Process; Provider; Psyche structure; Public Health; Quality of Care; Quasi-experiment; Research Personnel; Residential Facilities; Residential Treatment; Resistance; Stratification; Structure; Substance Use Disorder; System; United States Centers for Medicare and Medicaid Services; United States Substance Abuse and Mental Health Services Administration; Work; addiction; alcohol abuse therapy; behavioral health; beneficiary; career; cohort; cost; digital; evidence base; improved; improved outcome; insight; medical specialties; medically underserved population; medication for opioid use disorder; novel; opioid use disorder; overdose death; overdose risk; payment; policy implication; programs; skills; substance use treatment; treatment program; waiver

PROJECT SUMMARY Despite growing overdose fatalities primarily driven by opioids, only 10% of people with a substance use disorder (SUD) receive treatment. Yet evidence-based medication therapies that can reduce overdose risk exist, such as long-term buprenorphine maintenance therapy, but are vastly underutilized. As the most common insurer for people with opioid use disorder (OUD), the Medicaid program is uniquely positioned to improve access to evidence-based care and curb the tremendous toll of the overdose epidemic. However, prior work shows Medicaid beneficiaries face steep barriers accessing MOUD in outpatient settings due to low Medicaid provider participation and half of providers not accepting new Medicaid patients. Residential treatment programs are even less likely to participate in Medicaid than the outpatient setting due in part to the Institution for Mental Diseases (IMD) exclusion, a long-standing policy prohibiting federal matching of Medicaid payments for residential addiction treatment. Starting in 2015, states were able to apply for 1115 Substance Use Disorder IMD waiver demonstration projects, which would permit federal reimbursement for residential treatment. Waiver approval and renewal was contingent upon states proposing a plan to improve the accessibility and quality of their addiction treatment systems at large for Medicaid beneficiaries, including improving access to life-saving therapies such as buprenorphine. The long-term goal is to facilitate improved outcomes for individuals with SUD through transformation of the addiction treatment industry. The objective of the current application, which is the next step towards that goal, is to evaluate if IMD SUD 1115 waiver implementation is associated with changes in whether residential and outpatient treatment programs improve access to evidence-based behavioral health therapies for medically under-served populations. I use a quasi-experimental approach and consider outcomes in IMD waiver states before and after waiver implementation relative to states without waivers. The project’s PI and dissertation committee is an interdisciplinary team of health services researchers, health economists, and a physician with the methodological and substantive expertise to examine this understudied issue and explore its complex public health, clinical, and policy implications. The specific aims are to assess whether IMD waiver implementation is associated with changes in whether facilities accept Medicaid, offer any buprenorphine therapy (verses none), and offer buprenorphine maintenance therapy (verses no maintenance). The project is significant, as it focuses on how to structure reforms to address a key challenge in addiction treatment: incentivizing treatment programs to participate in Medicaid and offer evidence-based care. It is timely, as most waivers are coming up for review and findings can inform the Centers for Medicare and Medicaid Services’ renewal review process.

项目总结 尽管主要由阿片类药物导致的过量死亡人数不断增加，但只有10%的药物使用障碍患者 (南部)接受治疗。然而，存在可以降低过量用药风险的循证药物疗法，例如 长期的丁丙诺啡维持治疗，但远远没有得到充分利用。作为全球最常见的保险公司 有阿片类药物使用障碍(OUD)的人，医疗补助计划是独特的定位，以改善获得 循证护理和遏制过量用药流行病造成的巨大伤亡。然而，先前的工作表明 由于医疗补助提供者较少，医疗补助受益人在门诊设置中面临着访问Moud的巨大障碍 参与和一半的提供者不接受新的医疗补助患者。住院治疗项目是平均的 参加医疗补助的可能性低于门诊设置，部分原因是精神疾病研究所 (IMD)排除，这是一项长期政策，禁止联邦政府匹配住房医疗补助付款 上瘾治疗。从2015年开始，各州可以申请1115项物质使用障碍IMD豁免 示范项目，这将允许联邦政府补偿住院治疗。豁免审批 而更新取决于各国提出一项计划，以改善其可获得性和质量 医疗补助受益人的普遍成瘾治疗系统，包括改善获得救生的机会 丁丙诺啡等疗法。长期目标是促进SUD患者改善治疗结果。 通过成瘾治疗行业的转型。当前应用程序的目标是 迈向这一目标的下一步是评估IMD SUD 1115豁免的实施是否与变化相关 住院和门诊治疗计划是否改善了循证行为健康的获取 为医疗服务不足的人群提供治疗。我使用准实验的方法，考虑结果。 在IMD豁免实施之前和之后的州中，相对于没有豁免的州。项目的PI 和论文委员会是一个由卫生服务研究人员、卫生经济学家和 具有方法论和实质性专业知识的医生，以检查这一未被研究的问题并探索其 复杂的公共卫生、临床和政策影响。具体目的是评估国际管理发展学院是否放弃 实施与机构是否接受医疗补助、是否提供丁丙诺啡治疗的变化有关 (与无)，并提供丁丙诺啡维持治疗(与不维持)。这个项目意义重大， 它的重点是如何构建改革结构，以应对成瘾治疗中的一个关键挑战：激励 参与医疗补助和提供循证护理的治疗计划。这是及时的，就像大多数豁免一样 即将进行审查和调查结果可以通知医疗保险和医疗补助服务中心的续签审查 进程。