Effects of Medicaid IMD SUD waiver on access to addiction treatment

项目摘要 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%的物质使用障碍患者 (SUD)接受治疗。然而，存在可以降低过量风险的循证药物治疗，例如 长期丁丙诺啡维持治疗，但大大利用不足。作为最常见的保险公司， 阿片类药物使用障碍（OUD）的人，医疗补助计划是唯一的定位，以改善获得 以证据为基础的护理和遏制过量流行病的巨大代价。然而，先前的研究表明， 由于医疗补助提供者的低水平，医疗补助受益人在门诊环境中面临着获得MOUD的巨大障碍 参与和一半的供应商不接受新的医疗补助病人。住院治疗计划甚至 参与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，一项长期的政策，禁止联邦医疗补助计划支付的住宅匹配 戒毒治疗从2015年开始，各州可以申请1115物质使用障碍IMD豁免 示范项目，这将允许联邦报销住院治疗。豁免批准 和更新取决于各国提出一项计划，以改善其 为医疗补助受益人提供成瘾治疗系统，包括改善获得拯救生命的机会 丁丙诺啡等药物。长期目标是促进改善SUD患者的结局 通过改造戒毒行业。当前应用程序的目标，即 实现该目标的下一步是评估IMD SUD 1115豁免实施是否与变更相关 住院和门诊治疗项目是否能改善循证行为健康 医疗服务不足人群的治疗。我使用一种准实验方法， 在IMD豁免状态之前和之后，相对于没有豁免的状态，豁免实施。项目的PI 和论文委员会是一个跨学科的健康服务研究人员，健康经济学家， 具有方法学和实质性专业知识的医生来检查这个未充分研究的问题，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IMD豁免是否 实施与设施是否接受医疗补助，提供任何丁丙诺啡治疗 “不”，“不”。这个项目意义重大， 因为它专注于如何构建改革，以解决成瘾治疗的关键挑战：激励 参与医疗补助计划并提供循证护理。这是及时的，因为大多数豁免是 审查和调查结果可以告知医疗保险和医疗补助服务中心的更新审查 过程

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.