The Trump administration is urging states to better use Medicaid for the delicate and difficult treatment of opioid-addicted and exposed infants, but did not offer any new outlets.
Congress, however, might be delivering on that front shortly.
The Centers for Medicare & Medicaid Services (CMS) released guidance (PDF) Monday on how states can better design coverage for treatment services for Medicaid-eligible infants with neonatal abstinence syndrome (NAS) and their parents.
The document includes summaries of different treatment modalities, including hospital and home-based services, as well as ways Medicaid can support parents with substance abuse disorder. The CMS said states can create bundled rates for such services, instead of the traditional fee-for-service model.
"Through discussions with states, we have recognized their growing challenge in providing treatment services to the expanding number of infants with NAS," Tim Hill, acting director of the Center for Medicaid and CHIP Services, said. "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.”
Any fetus that is exposed to opioids in the womb can suffer withdrawal symptoms ranging from "mild" inconsolable crying, to moderate tremors, to severe problems with the brain, including cerebral palsy. A diagnosis of NAS is made after clinicians observe withdrawal symptoms in newborns in the days and weeks after birth.
The frequency of NAS has increased fivefold between 2000 and 2012, mostly driven by the current epidemic of opioid addiction, and now reaches about 6 per 1,000 births, or about 21,731 in 2012. Medicaid is the predominant payer of treatment services for NAS, covering more than 80% of infants treated for the disease.
According to the CMS, the American Academy of Pediatrics says infants should not be treated initially with medication, such as morphine, and recommends nonpharmacologic treatments like placing an infant in a dark quiet environment, swaddling, and feeding it high-calorie nutrition food in small feedings.
While healthcare experts consider the disease to be treatable, long-term ramifications for the infants are unknown.
At the same time, the agency also released material on how states can utilize federal funds for technology to combat drug abuse, such as enhanced prescription drug monitoring programs and improved access to telehealth.
However, the releases are only guidance documents and do not include any new policy or payment changes, which have been pushed by infant and opioid treatment groups.
The March of Dimes, for example, advocates for better access to drug treatment and social services for expecting mothers with opioid addiction, and expanded educational information on how taking opioids poses risks to unborn children. The organization also opposes policies that impose punitive punishments on pregnant women who abuse drugs, as threats of prosecution could drive expecting mothers away from treatment.
However, the industry might soon see some major progress on the legislative side.
The Senate Committee on Finance is scheduled to mark up an opioid crisis legislative package (PDF) on Tuesday, which would allow states to cover residential pediatric recovery services under Medicaid for infants and their mothers. Other provisions include additional opioid safety education and expanded telehealth coverage.
“Given the role that Medicare, Medicaid and human services programs play in our health care system, [we] have been committed to exploring how to improve these programs to better address substance use disorders,” Sen. Orrin Hatch, chairman of the committee, said in a statement. “After receiving stakeholder feedback, convening a hearing, and getting input from members, I am proud of this bipartisan package we have put together."