Many counties do not have medication for opioid use disorder (MOUD) services available through providers and treatment programs, and even in counties that do, Medicare and Medicaid beneficiaries often do not have access, says a recent report from the Department of Health and Human Services' Office of Inspector General.
The oversight office found that 19% of U.S. counties in 2022 did not have a MOUD provider, despite 100 of those counties in high need of MOUD services. Almost one-third of counties did not have a provider treating Medicare or Medicaid enrollees.
However, 77% of opioid treatment programs treat Medicare enrollees, unlike just 28% of office-based buprenorphine providers, though these programs are less common, the report (PDF) showed.
“In other recent OIG studies, we did not find a we did find a substantial number of Medicare enrollees and Medicaid enrollees that had a diagnosis for opioid use disorder were not receiving medications,” said Louis Day, a social science research analyst for OIG, in an interview with Fierce Healthcare. “So we did suspect that the there may be a substantial percentage of providers [who] were not treating enrollees.”
Medicare and Medicaid have covered MOUD since 2020, though Medicare Advantage plans often require prior authorization.
OIG analyzed Centers for Disease Control and Prevention (CDC) drug overdose mortality rates and compared them to county populations to see if the counties had a high rate of opioid or drug overdose deaths. They also used the CDC social vulnerability index to determine which counties may be best suited for more federal or state dollars to curb the opioid crisis.
After interviewing policy experts and related organizations, OIG was told low reimbursement rates disincentivize providers from treating enrollees. Those low rates are sometimes codified into state statutes.
Another reason for the widespread lack of access could be Medicare Advantage prior authorization requirements causing claim payment delays. Over 80% of Medicare Advantage beneficiaries must obtain prior auth for opioid treatment program services and outpatient substance abuse services, CMS learned.
The agency recommends pinpointing counties that need more providers for Medicare and Medicaid enrollees to increase access in those areas, and reevaluating the Medicaid reimbursement rates to ensure providers are recruited and retained. It also wants the Centers for Medicare & Medicaid Services (CMS) to work with the Substance Abuse and Mental Health Services Administration (SAMHSA) to keep an ongoing list of office-based buprenorphine providers.
CMS responded that it “supports the spirit” of the recommendations but did not say whether it agreed. A companion product was released by OIG that shows additional interactive displays diving into state-by-state analysis.