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Elizabeth M. Whitehorn, Director

Recommendations Page

Following are the recommendations of the OUD Withdrawal Management Subcommittee, as approved at the July 19, 2019 meeting:

Content of Care/Reimbursement

  • Revise Illinois Medicaid reimbursement policies to create payment models[1] that encourage providers[2] who treat opioid use disorder (OUD) to use the most current and accepted evidence-based OUD treatment approaches[3] including connection to ongoing community-based Medication Assisted Treatment (MAT) and/or other treatment[4].
  • In conjunction with the Illinois Department of Human Services (IDHS), examine service descriptions and withdrawal management protocols for ASAM Level 4.0, 3.7, 3.5 and 3.2 SUD treatment facilities to ensure they are consistent with OUD treatment best practices.

Follow Up Care/Discharge Planning

  • Provide clarification, guidance, advice, etc., concerning the sharing of patient information for 42 CFR Part 2 providers, and for other stakeholders when it comes to what can and cannot be shared in the context of care coordination.
  • Strengthen the transition planning process undertaken by withdrawal management providers, by establishing policies and procedures for community referrals and connections, as well ensuring that appropriate patient education and dispensing of medication to prevent overdose occurs as part of this planning process. These requirements could be tied to licensure and/or reimbursement

Reimbursement

  • Ensure that a broad range of Medicaid-covered services are available to persons with OUD in a variety of settings. This may include, but not be limited to:
    • Case Management[5]
    • Peer Recovery Supports
    • Crisis Intervention Services
    • Medication Administration and Monitoring
  • Review results of grant-funded efforts to address the opioid crisis (e.g. initiatives funded by the federal 21st Century Cures Act – State Targeted Response grants); use lessons learned to help inform efforts for Medicaid to support systems of care that encourage and reimburse for the services that lead to the best patient outcomes for those with OUD

Data and Measurement

  • Analyze the adoption of HEDIS measures that allow for accurate and appropriate capture of opioid use disorder (OUD) engagement and ongoing treatment; consider adopting as an MCO pay-for-performance measure
    • Review existing data to establish appropriate baseline

Other

  • Provide regular updates to the Medicaid Advisory Committee (MAC) and its relevant subcommittees on the status of adopted recommendations
  • Update/revise language in HFS statute, rules, and public communications to better reflect treatment options for persons with OUD that take into account the most current and accepted evidence regarding MAT. Work with other state agencies to make similar revisions

[1] Payment models discussed and debated by the committee included: incentives; withholds; tiered reimbursement based on different levels of achievement of the most current and accepted evidence-based clinical care/follow-up (e.g., gold, silver, bronze levels); additional input from various stakeholders should be considered when implementing new policies

[2] Prioritizing hospital-based providers that provide "traditional" withdrawal management (also referred to as detox) services with elements such as: rapid tapering (e.g., rapidly decreasing opioid agonist or partial agonist medications to zero over 3 days); lack of confirmed connection/appointment at discharge to community-based medication assisted treatment (MAT) and/or other care; and, lack of prescribing or providing the patient with medications for OUD treatment or overdose treatment at discharge.

[3] When clinically indicated and for patients who choose to undertake this course of treatment. For examples of evidence-based approaches and guidance, see: Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 18- 5063FULLDOC. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document-Including-Executive-Summary-and-Parts-1-5-/SMA18-5063FULLDOC, esp. pp. 33, 96, 218); and American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. Kampman K, Jarvis M. J Addict Med. 2015 Sep-Oct;9(5):358-67

[4] For a minimum period of time to be determined by departmental review of the most current and accepted evidence-based approaches, with community-based capacity in mind

[5] Clarify the ability for Medicaid to pay for case management services for persons with OUD. Leverage the Integrated Health Homes (IHH) model to provide enhanced payment and support for case management for persons with OUD. As necessary, pursue a State Plan Amendment to address gaps in Medicaid coverage for case management services for persons with OUD