The Effects of States' Substance Use Waivers on Healthcare Utilization and Opioid-related Overdoses Among Medicaid Enrollees with Opioid Use Disorder

各州的药物使用豁免对患有阿片类药物使用障碍的医疗补助参与者的医疗保健利用和阿片类药物相关过量的影响

• 批准号: 10617791
• 负责人: Stephan Reinhard Lindner
• 金额: $ 64.47万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617791
• 关键词: Address; Affect; Beds; Behavior Therapy; Buprenorphine; Caring; Case Management; Cessation of life; Clinical; Counseling; Data; Data Collection; Data Set; Death Rate; Disease; Elements; Eligibility Determination; Emergency Situation; Enrollment; Fibrinogen; Funding; General Hospitals; Health; Healthcare; Hospitals; Individual; Information Systems; Inpatients; Institution; Intensive Care; Interview; Knowledge; Laws; Medicaid; Medicaid services; Mental Health; Methadone; Methods; Naltrexone; Natural experiment; Office Visits; Opioid; Outcome; Outpatients; Patients; Persons; Pharmaceutical Preparations; Play; Policies; Policy Maker; Process; Provider; Psyche structure; Public Health; Public Policy; Relaxation; Research; Residential Facilities; Role; Services; Severities; Substance abuse problem; Time; United States; United States Centers for Medicare and Medicaid Services; addiction; beneficiary; care coordination; contextual factors; design; effectiveness evaluation; flexibility; health care service utilization; hospital utilization; improved; insight; opioid abuse; opioid epidemic; opioid mortality; opioid overdose; opioid use disorder; optimal treatments; programs; response; service utilization; substance use; substance use treatment; treatment guidelines; treatment services; waiver

Project summary Abuse of opioids is a public health crisis: in 2016, 2.1 million people had an opioid use disorder (OUD) and more than 40,000 people died from an opioid overdose. There is clear evidence that people with OUD can be effectively treated using medication and behavioral interventions such as counseling. Depending on the severity of the addiction, treatment can occur in outpatient settings (e.g., office visits for individual therapy) or might require more intensive care in inpatient settings such as residential facilities or hospitals. However, a large share of people with OUD still do not receive optimal treatment. Medicaid plays a crucial role in addressing the opioid crisis. It covers health care for almost 40 percent of people with OUD, and state Medicaid programs provide a variety of OUD treatment services affecting health outcomes for people with OUD. Some of these benefits are federally mandated (e.g., inpatient or ED services in general hospitals), while others are optional (e.g., medications, case management) and determined by public policy decisions at the state level. However, it is not clear what kind of policies are most successful in reducing the number of opioid overdoses among Medicaid beneficiaries. In 2015, the Centers for Medicare & Medicaid Services (CMS) issued guidance allowing states to receive federal funding to support substance use treatment through Section 1115 Medicaid waivers for “Institutions for Mental Diseases” (IMDs), defined as facilities with more than 16 beds that specialize in mental health or substance use treatment. In the absence of these waivers, federal law prohibits states from using federal matching funds to pay for Medicaid services provided in IMDs. The waivers relax this prohibition, while simultaneously requiring states implement a variety of other changes, including, for example, comprehensive OUD coverage, opioid treatment guidelines and care coordination among providers. Currently, 27 states have received an SUD waiver. This application proposes a comprehensive mixed-methods assessment of the effects of the Medicaid SUD waiver implementation. Our proposal has three aims. First, we use Medicaid claims data to examine the effect of the waiver on health care utilization, including medication use over time (2014-2021) and across states. Second, we assess the effect of the waiver on opioid-related overdoses. Third, we combine quantitative results with qualitative data collection to identify waiver elements and contextual factors that were associated with a successful reduction in opioid-related overdoses. The proposed research will provide critical information to state Medicaid programs about public policies that are most successfully addressing the opioid crisis.

项目概要 阿片类药物滥用是一场公共卫生危机：2016 年，210 万人患有阿片类药物使用障碍 (OUD)， 超过 40,000 人死于阿片类药物过量 有明确证据表明 OUD 患者可能会死亡。 使用药物和行为干预（例如咨询）进行有效治疗。 成瘾的严重程度，治疗可以在门诊进行（例如，就诊进行个体治疗）或 在住院设施或医院等住院环境中可能需要更多的重症监护。 很大一部分 OUD 患者仍未得到最佳治疗。 医疗补助在解决阿片类药物危机方面发挥着至关重要的作用，它涵盖了近 40% 的人的医疗保健。 OUD 患者和州医疗补助计划提供各种影响健康的 OUD 治疗服务 OUD 患者的结果中的一些福利是联邦政府规定的（例如住院或急诊服务） 在综合医院），而其他则是可选的（例如药物、病例管理）并由公众决定 然而，尚不清楚哪种政策在减少排放方面最成功。 医疗补助受益人中阿片类药物过量的数量。 2015 年，医疗保险和医疗补助服务中心 (CMS) 发布了指导意见，允许各州接收 通过第 1115 条医疗补助豁免为“机构”提供联邦资金支持药物滥用治疗 “精神疾病”(IMD)，定义为拥有 16 张以上床位、专门从事精神健康或治疗的机构 如果没有这些豁免，联邦法律禁止各州使用联邦药物治疗。 配套资金用于支付 IMD 中提供的医疗补助服务。豁免放宽了这一禁令。 同时要求各国实施各种其他变革，包括全面的变革 目前，27 个州已制定了 OUD 覆盖范围、阿片类药物治疗指南和医疗服务提供者之间的护理协调。 获得 SUD 豁免。 本申请提出了对医疗补助 SUD 效果的全面混合方法评估 我们的提议有三个目的：首先，我们使用医疗补助索赔数据来检查效果。 医疗保健利用豁免，包括一段时间内（2014-2021 年）和跨州的药物使用。 其次，我们评估豁免对阿片类药物相关过量的影响。第三，我们结合定量结果。 通过定性数据收集来识别与豁免相关的要素和背景因素 拟议的研究将为成功减少阿片类药物相关的过量用药提供重要信息。 州医疗补助计划涉及最成功解决阿片类药物危机的公共政策。

项目成果

State- and County-Level Geographic Variation in Opioid Use Disorder, Medication Treatment, and Opioid-Related Overdose Among Medicaid Enrollees.

• DOI: 10.1001/jamahealthforum.2023.1574
• 发表时间: 2023-06-02
• 期刊: JAMA HEALTH FORUM
• 作者: Lindner, Stephan R.;Hart, Kyle;Manibusan, Brynna;McCarty, Dennis;McConnell, John
• 通讯作者: McConnell, John