Opioid Use Disorder and Residential Treatment in Medicaid

摘要 Carrie E.Fry博士，医学博士，范德比尔特大学卫生政策系助理教授 医学。她是一名卫生服务和政策研究员，其投资组合专注于改善健康和 患有物质使用障碍(SUD)或精神疾病的美国人通过严格的 观察法和准实验法。这笔培训补助金将支持弗莱博士成为 独立研究人员，具有评估战略方面的专门知识，为影响边缘化群体的政策提供信息 美国人。这类专业知识的需求量很大：阿片类药物使用障碍的发生率和流行率。 自2010年代中期以来显著增加，相关危害包括急诊室就诊和死亡 过量，以类似的速度增加。获得循证治疗，特别是在医疗补助中 注册人数，并没有以同样的速度增加。出于这些原因，了解医疗补助政策有助于 增加获得治疗的机会对于抗击美国更广泛的SUD危机至关重要。单向州医疗补助计划 这些方案的回应是将连续护理范围扩大到包括住院治疗。从历史上看， 医疗补助计划不被允许为大多数成年人提供住宅性SUD治疗。遵循指导 2015年发布的这项法案，各州可以申请有时间限制的示范豁免，以扩大住宅的覆盖范围 治疗对象为21岁至之间的成年人。自那时以来，已有32个州获得批准并实施 第1115条豁免提供住宅性SUD治疗。各国在具体问题上有灵活性 这些豁免的规定可能会导致好坏参半的结果，以及扩大住宅面积的影响 医疗补助计划的治疗覆盖面在很大程度上是未知的。本K01中提出的研究将解决这些差距 为未来的政策提供信息。AIM 1将对参与医疗补助分发的13个州的医疗补助官员进行调查 研究网络(MODRN)，以确定医疗补助住院治疗覆盖范围的变化。然后，我会进行 对来自六个MODRN州的医疗补助和其他州官员的半结构化采访，以进一步探讨这些问题 不同之处。AIM 2将使用来自三个州的医疗补助索赔数据来提供可靠和可推广的证据 关于扩大住院治疗覆盖面对受益者层面健康和利用结果的影响。 从这些调查和采访中收集到的细节将被用来适当地与目标2的S结果相关联； 无论这些调查结果如何，目标2中提出的评价都可以完成。最后，目标3将产生第一个 对有OUD的医疗补助参与者中共病SUD的概括性估计，OUD是一个更有可能发生的亚群 获得住院治疗。这些AIMS的结果将为R01提供广泛的初步数据 评估目标3中确定的子人群中的这些覆盖范围扩展，并为未来的医疗补助提供信息 围绕居民待遇的政策。在导师的帮助下，弗莱博士确定了培训目标 在成瘾医学、国家卫生政策和行政索赔数据中的衡量问题上，将进一步 她在成为南德和医疗补助政策领域领先的独立研究员方面取得了进展。

ABSTRACT Carrie E. Fry PhD, MEd is an Assistant Professor in the Department of Health Policy in the Vanderbilt School of Medicine. She is a health services and policy researcher whose portfolio is focused on improving health and social outcomes for Americans with a substance use disorder (SUD) or mental illness through rigorous observational and quasi-experimental methods. This training grant will support Dr. Fry’s career goal of becoming an independent researcher with expertise in evaluation strategies to inform policy affecting marginalized Americans. This type of expertise is in high demand: the incidence and prevalence of opioid use disorder (OUD) has significantly increased since the mid-2010s with related harms, including emergency room visits and fatal overdoses, increasing at a similar pace. Access to evidence-based OUD treatments, especially among Medicaid enrollees, has not increased at the same rate. For these reasons, understanding the Medicaid policy levers to increase access to treatment is crucial to combatting the broader SUD crises in the US. One way state Medicaid programs have responded is by expanding the continuum of care to include residential treatment. Historically, Medicaid programs not been allowed to provide residential SUD treatment for most adults. Following guidance issued in 2015, states could apply for time-limited, demonstration waivers to expand coverage for residential treatment to adults between 21-64 years old. Since then, 32 states have received approval for and implemented a Section 1115 waiver to provide residential SUD treatment. States have flexibility regarding the specific provisions of these waivers potentially leading to mixed outcomes, and the impact of expanded residential treatment coverage in Medicaid is largely unknown. The research proposed in this K01 will address these gaps to inform future policy. Aim 1 will survey Medicaid officials in the 13 states participating in the Medicaid Distributed Research Network (MODRN) to identify variation in Medicaid residential treatment coverage. Then, I will conduct semi-structured interviews with Medicaid and other state officials from six MODRN states to further explore these differences. Aim 2 will use Medicaid claims data from three states to produce reliable and generalizable evidence on the effect of expanded coverage for residential treatment on beneficiary-level health and utilization outcomes. Details gleaned from these survey and interviews will be used to appropriately contextualize Aim 2’s results; the evaluation proposed in Aim 2 can be completed regardless of these findings. Finally, Aim 3 will produce the first generalizable estimates of co-morbid SUD among Medicaid enrollees with OUD, a subpopulation more likely to access residential treatment. Results from these aims will provide extensive preliminary data for an R01 evaluating these coverage expansions among sub-populations identified in Aim 3 and inform future Medicaid policy around residential treatment. With the assistance of her mentors, Dr. Fry has identified training objectives in addiction medicine, state health policy, and measurement issues in administrative claims data that will further her progress toward becoming a leading, independent researcher in the field of SUD and Medicaid policy.