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CMS: Use Health IT, Medicaid Coverage Options to Combat Opioids

CMS will help states combat the opioid crisis by ensuring they have the necessary tools and strategies in place to support Medicaid beneficiaries struggling with addiction.

CMS says that states should use health IT and Medicaid coverage options to combat opioids

Source: Thinkstock

By Jessica Kent

- CMS has released two documents describing how states can leverage Medicaid services and health IT tools to support beneficiaries battling opioid addiction.

The organization released an Informational Bulletin to guide states on how to cover critical treatment services for Medicaid eligible infants with Neonatal Abstinence Syndrome (NAS), a postnatal drug withdrawal syndrome occurring primarily among babies exposed to opioids during gestation or shortly after birth.

One in 25 infants in the US are born with the condition, and 80 percent of those children receive care through Medicaid.

“Today’s guidance further builds on CMS’s 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 Tim Hill, Acting Director for the Center for Medicaid and CHIP Services. 

“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.”

NAS is a treatable result of a women’s prenatal opioid or other substance abuse. Appropriate treatment, which can occur in the hospital and in other settings, can help affected infants lead healthier lives.

“NAS is a significant and rapidly growing public health concern,” said Hill. “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,” he said.

CMS noted that it is important for states to engage mothers and caregivers in the infant’s care and ensure that they use intervention methods such as swaddling and skin-to-skin contact.

States could also aim to cover initial or ongoing substance use disorder treatment services for Medicaid-eligible mothers and fathers alongside NAS treatment services. Offering immediate treatment for both infants and their caregivers provides them with the best chance for positive long-term outcomes.

In addition to the Informational Bulletin on treating NAS, CMS released a letter describing how states can best use federal funding to improve Medicaid technology and control the opioid epidemic.

The letter aligns with the final report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis.  The report highlights telemedicine and prescription drug monitoring tools as useful technology to combat opioid addiction.

States can access enhanced federal funding to incorporate innovative methods of treating substance abuse into Medicaid care coordination technologies.  Programs are encouraged to use explore the use of virtual treatment centers or remote counseling. These strategies would be particularly helpful in rural areas and in other places struggling with provider shortages.

The letter also discussed how states can receive federal support for shared electronic health plans, which would allow patients and providers to view and update a shared care plan and set goals for pain management regimens and counseling.

Additionally, CMS said that states should work to develop single sign-on interoperability between electronic health records (EHRs) and prescription drug monitoring programs to reduce provider burden and allow physicians to e-prescribe in the same platform as the EHR.

Developing health IT tools to analyze data from public health surveillance initiatives could also help strengthen the understanding of the crisis, the letter said.

Moreover, states could use systems and funding to support advanced analytics and create prediction models for patients at high risk of opioid dependency.

CMS expects that these two documents will help states leverage Medicaid services and provide support for beneficiaries struggling with opioid addiction.  

“Today’s announcement reflects 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,” said HHS Secretary Alex Azar.

“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.” 


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