Manatt and Arnold Ventures release Medicaid policy toolkit for opioid crisis
Manatt, a law and consulting firm, and philanthropy Arnold Ventures released a policy toolkit to guide state Medicaid leaders as they tackle the opioid crisis – which causes 70,000 deaths annually in the US. Manatt Health, the firm’s healthcare legal and consulting group, developed the roster of evidence-based strategies with the support of Arnold Ventures.
“Medicaid is the bedrock of states’ efforts to combat the opioid epidemic sweeping across America,” said Patricia Boozang, senior managing director with Manatt Health and the Toolkit’s lead author. “The Toolkit is designed to help state leaders identify Medicaid strategies from around the nation to expand treatment and recovery supports to those with opioid use disorder (OUD), implement in their respective states, and then evaluate and expand what works in order to help bring an end to this epidemic.”
The passage of the SUPPORT Act in fall 2018 means that some of the strategies in the toolkit will become mandatory or incentivized activities for state Medicaid agencies.
The report first recommends increasing access to medication-assisted treatment (MAT), which combines behavioural therapy and medications – currently buprenorphine, methadone, and naltrexone. The gold standard in biomedical care for opioid use disorder, MAT is effective in reducing death rates and other harms.
States shape the extent to which a drug is accessible by placing it on a preferred drug list (PDL). As such, Manatt’s report recommends states review and update their PDL to make sure all formulations of medications needed for MAT are on the preferred list. States should also create a written policy for Medicaid providers which communicates that all MAT drugs are covered, and outlines the procedures used to obtain treatment.
As an example, Washington, DC’s PDL has all oral, injectable, and implantable forms of buprenorphine and naltrexone as preferred, and none require prior authorization.
Second, the report recommends that states promote coordinated team-based care for OUD treatment, which research indicates leads to improved outcomes for a range of health conditions, while boosting patient satisfaction. A team generally consists of a physician or nurse authorized to prescribe MAT medications, a mental health or substance abuse professional, a care manager to help navigate health and social services, and a peer support specialist.
States should establish a definition of team-based care, develop a state plan for authorizing reimbursement for peer support specialists, and create a process for certifying qualified teams while increasing payment to providers meeting state standards.
Virginia established enhanced reimbursement for team-based care for OUD treatment following a review in 2017. The state’s office-based opioid treatment (OBOT) providers must include a buprenorphine-waivered practitioner collaborating with a licensed psychologist, social worker, or another credentialed addiction treatment practitioner. In the first ten months after implementation, Virginia saw a 64% increase in treatment rates and a 24% drop in emergency department visits for OUDs.
Third, the Manatt report recommends that states monitor and evaluate OUD interventions on an ongoing basis. As states implement a broad array of interventions, they need to know what is and isn’t working. As such, they should develop a monitoring plan with metrics for gauging Medicaid’s overall performance in fighting the OUD epidemic. This can include the creation of quarterly reports and a dashboard for viewing trends over time.
States should then take the insights of the metrics and evaluations to modify current programs and inform future planning and investments.
North Carolina, for example, implemented an Opioid Action Plan Data Dashboard which provides visualizations of each metric, displaying rates at the county level on 13 measures, including opioid overdose deaths and MAT prescription stats.
