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Reducing Substance Use Disorders: A Look Back Over the Past 12 Months and Our Upcoming Plans to Support States’ SUD Delivery System Reform Efforts

As the need for developing robust approaches for addressing substance use disorders becomes increasingly clear, CMS has been working directly with a set of leader states through our Medicaid Innovation Accelerator Program (IAP). Seven states participate in an intensive learning collaborative and 48 states have participated in a monthly web-based learning series entitled, Targeted Learning Opportunities (TLO). In April, we will kick off a four-part webinar series to share what we and our partner states have learned during the first year of IAP’s Reducing Substance Use Disorders (SUD) program area.

High-Intensity Learning Collaborative

Over the last year, seven states participating in the High-Intensity Learning Collaborative (HILC) strengthened their programs for Medicaid beneficiaries with SUDs. Using a cadre of experts, IAP offers each HILC state technical support to tailor solutions to its own needs and to develop relevant policy, program, and delivery system reforms. Each state defined measurable goals and used a range of tools, including virtual monthly meetings, in-person workshops, and one-on-one technical support from dedicated coaches. The types of technical support include assistance with:

  • resources regarding care transitions and treatment engagement following withdrawal management;
  • model SUD health home design and managed care contract language;
  • administrative claims and managed care organization encounter data standardization;
  • coding language development to implement measures reporting, including Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (NQF #0004) and Follow-up after Discharge from the Emergency Department for Mental Health or Alcohol or Other Drug Dependence (NQF #2605); and
  • return-on-investment research and data analyses to support program spending evaluation methodology and reporting.

We will continue to support HILC states by providing limited access to their dedicated coaches. In addition, these states have requested to stay connected as a group through quarterly, virtual state-to-state discussions to share the progress, challenges, and solutions.

Targeted Learning Opportunities

Over the past year, we hosted 12 webinars called Targeted Learning Opportunities (TLOs) with 48 Medicaid programs participating. These TLOs connect states to content experts and leading practices across the country on a number of topics within SUD delivery system reform, such as encouraging SUD provider participation in Medicaid and the integration of primary care and SUD services.

There are two TLOs scheduled in April and May/June, focusing on pay-for-performance approaches and the opioid prescribing guidelines recently published by the Centers for Disease Control and Prevention, respectively. In addition, we will soon be posting slides from select TLOs on Medicaid.gov.

Section 1115 Demonstration for SUD Delivery System Reform

In July 2015, CMCS issued guidance on a new opportunity under the section 1115 demonstration authority to develop a full continuum of care for individuals with SUD. In August 2015, CMCS approved the first SUD 1115 project in California. Through the IAP, we now offer targeted strategic planning support to states applying for a Section 1115 demonstration (PDF, 205.64 KB) focused on SUD. Contact Tyler Sadwith (Tyler.Sadwith@cms.hhs.gov) if your state is interested pursuing this opportunity.

Emerging Areas for Program Support

Over the next year, the IAP SUD team will continue to support our state Medicaid partners by developing webinars, fact sheets, and other types of program support tools. Based on feedback from the HILC states and the state Medicaid programs that participated in TLOs, we have identified the following topics of interest for states focused on implementing delivery system reforms related to SUD:

  • Managed care contracting (e.g., examples of core behavioral health managed care contracting elements, including: benefit array, provider credentialing, performance measurement strategies, and alternative payment mechanisms).
  • Performance measurement and data dashboards (e.g., disseminating nationally-recognized performance measures and highlighting strategies for sharing and linking administrative data) 
  • Network adequacy (e.g., efforts to define, measure, and assess network adequacy and access)
  • Value-based purchasing (e.g., potential application of existing health care value-based purchasing models to SUD).
  • Medication-assisted treatment (MAT) (e.g., developing tools for improving quality and assuring integrity in MAT as well as disseminating clinical pathways and practice guidelines).

National Dissemination

We have packaged the most prominent themes and topics that surfaced during the first year of IAP’s SUD work and are ready to share them with Medicaid programs and our other key partners and stakeholders across the country. We are holding a four-part webinar series that kicks off April 6, 2016. For this first webinar, we invited several HILC states to discuss their IAP experience and trajectory. We believe an effective way to connect states and stakeholders with our work is to provide a forum for the HILC states to:

  • Share their key takeaways and insights from their participation in the IAP,
  • Present their project goals, progress and implementation activities,
  • Highlight lessons learned, recommendations and solutions for other states embarking on this path.

You can register for the webinar by visiting the following site: https://www.eventbrite.com/e/national-dissemination-kick-off-hilc-state-panel-registration-22541769038. In advance of the April webinar, we will provide more details on these states’ IAP activity. Learn more about IAP’s SUD work.

IAP Commentary
John O'Brien, Senior Policy Advisor, CMCS and Tyler Sadwith, Health Insurance Specialist, Disabled and Elderly Health Programs Group, CMCS


Collections: IAP Commentary