Medicaid managed care organizations will soon have a new
opportunity to address the growing and costly burden of maternal opioid misuse.
Just a day before President Trump signed a sweeping package of bills addressing
the opioid epidemic, CMS on Oct. 23 unveiled the Maternal Opioid Misuse (MOM)
model. Under that program, the Innovation Center will award up to 12
cooperative agreements with states, whose Medicaid agencies will implement the
model with one or more "care-delivery partners" in their communities,
including health plans.
In a fact sheet unveiling the model, CMS said it is intended to
"address fragmentation in the care of pregnant and post-partum Medicaid
beneficiaries with opioid use disorder (OUD) through state-driven
transformation of the delivery system surrounding this vulnerable
population" and to ensure that mothers with OUD receive a comprehensive
set of services delivered in a coordinated and integrated fashion.
Not only has there been a surge in recent years in substance-use
related illness and death among pregnant and postpartum women, but the number
of babies born with neonatal abstinence syndrome (NAS) — an opioid withdrawal
syndrome that can lead to lengthy and costly hospital stays — jumped 300%
between 1999 and 2013 in 28 states with publicly available data on opioid
addiction. And Medicaid pays the largest portion of hospital charges for
maternal substance use, as well as the bulk of the $1.5 billion annual cost of
NAS, according to CMS.
Yet despite this significant impact, opioid-addicted pregnant
women face various barriers to treatment. The MOM model will award cooperative
agreements to states to support Medicaid agencies, providers and health systems
to address the fragmentation of care that currently exists. The state will be
expected to complete the application, which must demonstrate that it has teamed
up with at least one care-delivery partner, which could be a health system or
payer, suggested CMS. State Medicaid agencies will develop and implement
coverage and payment strategies, while their partners will provide services to
beneficiaries.
To support the model's goals, a maximum of $64.6 million will be
distributed among up to 12 state awardees over a five-year period.
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