Medicaid Managed Care Coverage and Utilization Management of Opioid Use Disorder Treatment

项目摘要 随着国家继续努力应对阿片类药物过量和死亡率迅速变化的流行病， 越来越多的公众关注扩大阿片类药物使用障碍（OUD）治疗的机会。而 医疗补助被定位为改善OUD治疗和降低死亡率的关键政策杠杆 在弱势人群中，许多州的医疗补助计划并没有覆盖OUD的全部连续性 可能限制访问的治疗和使用利用管理参数。此外，大多数州医疗补助 与管理式护理组织（MCOs）签订合同。而超过70%的医疗补助注册者 尽管参与MCO计划的人很少知道这些计划如何涵盖OUD治疗。为了填补这一空白， 科学证据，我们将进行第一次多州研究的影响，医疗补助MCO覆盖面， OUD治疗接收和结果的使用管理设计。这项研究将开辟新的领域， 涵盖多个州的所有MCO计划，以实现完整的连续治疗。我们亦建议 在两个州的医疗补助计划中使用创新的随机自动分配方法。我们的具体目标 将包括：估计州医疗补助计划合同规定和监督如何与 MCO计划级覆盖和利用率设计;评估MCO计划的覆盖和利用率 管理设计与通过护理级联（诊断，参与， 药物启动和保留）;以及估计MCO计划的覆盖范围和使用管理 参数与阿片类药物相关的急诊就诊、住院和死亡率相关。 拟议的研究将是首次全面调查MCO覆盖对OUD的影响 治疗服务和药物治疗接收和结果-证据，没有它的照顾， 大部分的OUD群体受到损害。这项研究还将产生新的见解， 正在规范和监测MCO计划覆盖范围和利用管理设计。你在这些 美国历史上最致命的毒品流行病，关于医疗补助MCO覆盖范围对 因此，迫切需要进行治疗。这项研究将为决策者提供基于证据的指导， 如何构建MCO合同安排，以确保适当和有效地获得OUD治疗。

PROJECT SUMMARY As the nation continues to grapple with a rapidly changing epidemic of opioid overdose and mortality, there has been increasing public attention devoted to expanding access to opioid use disorder (OUD) treatment. While Medicaid is positioned to be a key policy lever to improve access to OUD treatment and reduce mortality among vulnerable populations, many state Medicaid programs do not cover the full continuum of OUD treatment and use utilization management parameters that may restrict access. Moreover, most state Medicaid programs contract with managed care organizations (MCOs). While over 70% of all Medicaid enrollees participate in MCO plans, little is known about how these plans cover OUD treatment. To fill this gap in the scientific evidence, we will conduct the first multi-state study of the effects of Medicaid MCO coverage and utilization management design on OUD treatment receipt and outcomes. The study will break new ground by encompassing all MCO plans, across multiple states, for the full continuum of treatment. We also propose to make use of innovative random auto-assignment methods in two state Medicaid programs. Our specific aims will include: estimating how state Medicaid program contractual regulations and oversight are associated with MCO plan level coverage and utilization design; estimating how MCO plans’ coverage and utilization management design are associated with progression through the Cascade of Care (diagnosis, engagement, medication initiation, and retention); and estimating how MCO plans’ coverage and utilization management parameters are associated with opioid-related emergency department visits, hospitalizations, and mortality. The proposed study will be the first comprehensive investigation of the effects of MCO coverage for OUD treatment services and medications on treatment receipt and outcomes – evidence without which the care of a large fraction of the OUD population is compromised. The study will also produce new insight into how states are regulating and monitoring MCO plan coverage and utilization management design. In the midst of the deadliest drug epidemic in the nation’s history, evidence regarding the impact of Medicaid MCO coverage for OUD treatment is urgently needed. This research will equip policymakers with evidence-based guidance on how to structure MCO contractual arrangements to ensure appropriate and efficient access to OUD treatment.