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Technical Resources for States: Medication-Assisted Treatment Bundled Payments

For the past two years, The Medicaid Innovation Accelerator Program (IAP) has been working with Medicaid and behavioral health agencies to develop robust approaches for addressing substance use disorders (SUD). As described in the IAP High Intensity Learning Collaborative fact sheet (PDF, 81.74 KB), we have been working with a small group of leader states on their SUD delivery system reform activities. Additionally, we provide strategic design and technical support to a number of states pursuing section 1115 demonstration projects for SUD as outlined in the 2015 CMS State Medicaid Director letter (PDF, 205.64 KB). Through our close work with states under various IAP SUD activities, we have developed tools and resources designed to support state efforts to introduce policy, program, and payment reforms appropriate for a robust SUD delivery system.

In this month’s commentary, we want to introduce you to IAP’s work in developing “starting point” resources related to designing episodes of care and payment bundles for medication-assisted treatment (MAT) services delivered to individuals with opioid dependence. In July 2015, the Medicaid IAP responded to a request from a state to support their efforts to develop a bundled payment rate for MAT with buprenorphine to treat opioid dependence. In response to that request, the IAP team began by identifying strong examples of MAT models currently in use in state Medicaid programs as a basis for developing the bundled payment methodology. The models selected include:

  • an office-based opioid treatment program model based on Vermont’s “Hub and Spoke” program;
  • an office-based opioid treatment program model in operation in Massachusetts; and
  • a model that uses specialty providers to begin MAT and transfers patients to primary care practices for continuing care, based on the “Baltimore Buprenorphine Initiative” endorsed by Maryland.

The next step was to develop a rate model to reflect the costs of providing the clinical services in each model by: constructing clinical pathways corresponding to each MAT service delivery model; identifying distinct phases of treatment; and delineating the sites, types and time requirements of professional staffing for each phase. The clinical pathway articulates the services that underlie the rates, and the rate model allows states to adjust factors to reflect local practice and costs, including the composition of professional staff, time required for each step, staff costs, and other direct and indirect costs.

We will soon post to the IAP SUD webpage a clinical pathway document and a companion rate model for each of the three example MAT models! It is our hope that these resources can be used by states as a “starting point” for considerations, discussion, and planning around bundled MAT services and payments.

If you would like to know more about these MAT bundled payment model resources, join us for a national webinar from 3:30pm-5:00pm ET on January 17, 2017. During the January webinar, Vermont and Massachusetts will share how they designed and implemented their MAT programs. Register here for the webinar.

Collection
IAP Commentary
Author
Tyler Sadwith, Health Insurance Specialist, Disabled and Elderly Health Programs Group, CMCS
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