CMS
NEWS
FOR IMMEDIATE RELEASE
June 11, 2018
Contact: CMS Media Relations
CMS leverages Medicaid Program to combat the
Opioid crisis
States
provided guidance in designing treatment options for Opioid Epidemic
Today, the Centers for Medicare
& Medicaid Services CMS released guidance aimed
at building on our commitment to partner with states to ensure that they
have flexibilities and the tools necessary to combat the opioid
crisis. This new guidance provides
information to states on the tools available to them, describes the types
of approaches they can use to combat this crisis, ensures states know what
resources are available, and articulates promising practices for addressing
the needs of beneficiaries facing opioid addiction. Notably, CMS
released an Informational Bulletin that provides states with information
they can use when designing approaches to covering critical treatment
services for Medicaid eligible infants with Neonatal Abstinence Syndrome
(NAS). Additionally, CMS issued a letter to states on how they may best use
federal funding to enhance Medicaid technology to combat drug addiction and
the opioid crisis.
“The number of American infants
born dependent on opioids each day is heartbreaking,” said HHS Secretary
Alex Azar. “Today’s announcement reflects the Trump Administration and
HHS’s commitment to helping states use Medicaid to support treatment for
this condition and other challenges produced by our country’s crisis of
opioid addiction. State-level innovation, including in the use of
prescription drug monitoring programs and electronic health records, has
been and will be a key piece of ending this crisis.”
Addressing Neonatal
Abstinence Syndrome
Medicaid services can play a
critical role in helping ensure access to treatment for these vulnerable
infants who have Neonatal Abstinence Syndrome (NAS). Neonatal Abstinence
Syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs
primarily among opioid-exposed infants shortly after birth. Experts
consider NAS to be an expected and treatable result of women’s prenatal
opioid or other substance use, although long term ramifications for the
infants are still unknown. As of 2012, there was an average of one
infant born with NAS every 25 minutes in the United States and roughly 80
percent of infants treated for NAS receive their care through Medicaid.
“NAS is a significant and
rapidly growing public health concern,” said Tim Hill, Acting Director for
the Center for Medicaid and CHIP Services. “The number of infants born with
a diagnosis of NAS is increasing significantly. This rapid growth is
directly related to the opioid crisis facing this country. Through
discussions with states, we have recognized their growing challenge in
providing treatment services to the expanding number of infants with
NAS. We have also recognized that states may not be fully aware of
available options under Medicaid that can play a critical role in the care
of these infants, as well as the limitations on Medicaid coverage.”
Appropriate treatment using the
best evidence-based practices can help these infants withdraw from opioids
and other substances and lead healthier lives. NAS treatment may
occur not only in hospitals, but also in other settings. In addition
to Medicaid-covered treatment for infants, it is important for states to
involve mothers and other caregivers in the infant’s care, as appropriate.
The use of interventions like swaddling, quiet environments, little stimulation,
skin-to-skin contact, and other environmental approaches are critical first
line care for these infants.
States may also seek to cover
initial or ongoing SUD treatment services for Medicaid-eligible mothers
and/or fathers concurrently with NAS treatment services directed at the
infant. Services that begin at this critical time, and continue to follow
and support the infant and caregiver when the infant returns home, provide
the highest likelihood for optimal health status and positive outcomes for
infants born with NAS. Medicaid services can play a critical role in
helping ensure access to treatment for these vulnerable infants and their
families.
Enhancing
Medicaid Technology
The opioid technology guidance
advises states on which funding authorities may support health information
technology efforts that could be used for the prevention and treatment of
negative opioid outcomes.
The guidance falls in line with
the President’s Commission on Combating Drug Addiction and the Opioid
Crisis
final report released on November 1, 2017. Specifically, this report
singles out telemedicine and prescription monitoring tools as useful in the
effort to combat the opioid crisis.
States may access enhanced
federal funding to integrate innovative substance abuse treatment in areas
facing provider shortages, particularly in rural areas, such as virtual
treatment centers or remote counseling, into Medicaid care coordination
technologies. The letter also describes how states can draw federal support
for shared electronic care plans, which allows patients and providers to
view and update a shared care plan describing goals for pain management
regimens and counseling, and could complement Medication Assisted Therapy
(MAT).
Support for Patient-facing
technology in the form of apps and remote monitoring technology is also
mentioned as possible state technology investments eligible for funding.
Further, states may reduce provider burden by creating a single sign-on
interoperability between Electronic Health Records (EHRs) and prescription
drug monitoring programs, allowing physicians to e-prescribe in the same
platform where electronic health records are held.
Enhanced technologies, which
might support the development of public health surveillance, may also be
developed that can help strengthen the understanding of the crisis through
better public health data and reporting. Most notably, the letter describes
how states might draw federal financing to support recommendations from the
President’s Commission final report, such as integrating prescription drug
monitoring systems data into EHRs and supporting interstate data sharing
and electronic prescribing of controlled substances. In addition, the
letter shows how states might use systems and funding to support advanced
analytics for those looking to leverage data sources to create prediction
models of patients at risk for opioid dependency and connect them with
appropriate case management.
“Today’s guidance further
builds on CMS’ commitment to provide states with
the tools and approaches available within
the Medicaid program to accelerate states’ ability to respond to the
national opioid crisis” said Hill, “By leveraging and improving the
technological capabilities of state Medicaid programs, we are providing
Medicaid agencies, providers, and patients with the tools they need to
improve health outcomes associated with addiction.”
Both sets of guidance
compliment a State Medicaid Director (SMD) letter, “Strategies to Address
the Opioid Epidemic” (SMD
17-003), issued on November 1, 2017 that outlines state
flexibility in addressing the opioid crisis via demonstration projects
under section 1115 of the Social Security Act. There are a number of ways
technology might support those efforts, but a state need not be
participating in a section 1115 demonstration project to take advantage of
the enhanced federal funding opportunities described in today’s SMD. To
date, CMS has approved SUD-related section 1115 demonstration projects in
Louisiana, West Virginia, Indiana, New Jersey, Kentucky, Utah, Illinois,
and Vermont to allow these states to improve access to the full spectrum of
quality SUD care and treatment for Medicaid beneficiaries.
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