Addressing the opioid crisis is a top priority for the Trump
Administration and the Centers for Medicare & Medicaid Services (CMS).
CMS is committed to preventing and reducing opioid use disorder by
promoting safe opioid prescribing and encouraging non-opioid pain
treatments. Over the last several years, we have issued several
Informational Bulletins outlining state approaches and effective practices
for addressing the opioid overdose epidemic within Medicaid. Today, we
continue that effort, by releasing two Informational Bulletins.
First, an Informational Bulletin providing clarification to states about
section 1007, “Caring Recovery for Infants and Babies”, in the
Substance Use-Disorder Prevention that Promoted Opioid Recovery and
Treatment (SUPPORT) for Patients and Communities Act was released. This
provision added a new section 1902(a)(86) to the Social Security Act (Act)
to add an optional provider type of “residential pediatric recovery center”
(RPRC) to Medicaid for treatment of infants with Neonatal Abstinence
Syndrome (NAS) without any other significant medical risk factors. This
Informational Bulletin provides information to states on how they may cover
services for infants with NAS via this new provider type in their Medicaid
programs. It also provides information to states on implementation of
provisions in section 1007 of the SUPPORT Act that specify that RPRCs may
offer counseling and other services to mothers (and other appropriate
family members and caretakers) of infants receiving treatment at such
centers if such services are otherwise covered under the state plan under
this title or under a waiver of such plan.
A second Informational Bulletin released today to provide information to
states on section 1012, “Help for Moms and Babies”, in the Substance
Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for
Patients and Communities Act, (SUPPORT) for Patients and Communities Act.
Section 1012 creates a new limited exception to the institution for mental
diseases (IMD) exclusion for pregnant and postpartum women with substance
use disorders. Generally, Medicaid coverage is not available for services
provided to beneficiaries while they reside in an IMD defined in statute as
a “hospital, nursing facility, or other institution of more than 16 beds,
that is primarily engaged in providing diagnosis, treatment, or care of
persons with mental diseases including medical attention, nursing care, and
related services.” This exclusion refers to services provided to
beneficiaries within the IMD setting as well as services provided outside
of the IMD. Section 1012 establishes a new exception to the IMD exclusion
for pregnant women who are receiving treatment in an IMD for an SUD to
allow Medicaid coverage of items and services provided outside of the IMD.
This Information Bulletin provides information on how states may implement
this new exception to the IMD exclusion.
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