Transforming the Delivery of Substance Use Disorder Treatment in States Update August 2019

Drug-related Deaths (2017) National: 70,237 Historical Trends (2010 - 2017) Legend 16 to 156 660 to 1,030 156 to 361 1,030 to 1,587 361 to 660 1,587 to 5,388 The total number of deaths from drug poisoning, including both illicit and prescription drugs. Data Source: Centers for Disease Control and Prevention Source: amfAR. Opioid & Health Indicators Database. https://opioid.amfar.org/. Accessed August 13, 2019.

ASAM ADVOCACY Teach It Standardize It Cover It

Teach It Teach addiction medicine by expanding and strengthening our workforce and dispelling stigma

Teach It States are using federal and state funds to deliver high-quality, competency-based addiction medicine education

Teach It + Ohio New York Kentucky

Teach It Louisiana Alabama Indiana Kentucky Alaska

Standardize It Standardize the delivery of addiction medicine so that more patients receive high-quality, evidence-based care

State Treatment Program Licensure Regulations: Standardize It State Treatment Program Licensure Regulations: Do they require the use of a multidimensional patient assessment? What are the clinical decision rules being used by clinicians for an accurate level of care recommendation? Are the treatment program licensure standards according to nationally-recognized levels of care? And are those components part of one ecosystem developed by experts and based on research?

Standardize It The ASAM Criteria® provides the ecosystem that can help a state answer these questions, serve as a roadmap to design regulations, and transform the delivery of SUD treatment in states.

Standardize It Implementation of The ASAM Criteria® can improve the addiction treatment system, but only if it is implemented comprehensively and effectively

Standardize It ASAM Levels of Care Service Characteristics of ASAM Level of Care Addiction Treatment Program Standards

ASAM Level of Care 3.5 at a Glance Support Systems Consultation with physician, physician assistant or nurse practitioner Emergency services 24/7 Direct affiliation or coordination with other levels of care Arranged medical, psychiatric, psychological, laboratory, and toxicology services Therapies Daily clinical services to improve patient’s ability to structure and organize the tasks of daily living and recovery Counseling and clinical monitoring Individual and group evidence-based cognitive, behavioral, and other therapies Addiction pharmacotherapy Monitoring of patient’s adherence in taking any prescribed medications Assessment/Treatment Plan Review Biopsychosocial assessment of patient’s substance use disorder conducted by staff who are knowledgeable about addiction treatment Biopsychosocial assessment and treatment plan updates Physical examination Staff Licensed or credentialed clinical staff such as addiction counselors, social workers, and licensed professional counselors Allied health professional staff, on-site 24 hours One or more clinicians with competence in the treatment of substance use disorders, available 24 hours

Standardize It CMS 1115 SUD Waiver Guidance (November 1, 2017): Demonstrate standardized assessment tool Demonstrate standardized delivery system, including residential treatment provider qualifications

Standardize It ASAM Level of Care Certification Partnership between ASAM and CARF. The ASAM Criteria® is nation’s most widely used and comprehensive set of guidelines for addiction treatment, but there is currently no verification of its implementation. Accurately differentiate between levels of care to help patients and payers alike. Highlight treatment programs that have evidence-based policies and procedures.

Cover It Cover addiction medicine in a way that expands patient access to coordinated, comprehensive care

Cover It Virginia’s Addiction and Recovery Treatment Services Program (ARTS) Implemented in 2017 to increase access to treatment for Medicaid members with opioid use disorders (OUD) and substance use disorder (SUD). ARTS benefits are based on the ASAM Criteria and cover a full spectrum of addiction treatment services. ARTS services include inpatient withdrawal management, residential treatment, partial hospitalization, intensive outpatient programs, opioid treatment, peer recovery, and case management. They are carved into existing Medicaid managed care plans to support full integration of behavioral and physical health.

Cover It Parity at the State Level State efforts to fully implement and enforce the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Parity issues specific to addiction treatment: Coverage of medications to treat SUD without utilization controls like prior authorization and step therapy. Coverage on the lowest tier of insurers’ drug formularies. Tying medical necessity criteria to The ASAM Criteria.

Cover It At least four states have passed state legislation codifying a requirement that payers use The ASAM Criteria to make medical necessity decisions/coverage determinations: Connecticut Delaware Illinois Rhode Island

Multidimensional Assessment Implements Hundreds of ASAM Decision Rules Multidimensional Assessment Readiness & Screening Diagnosis Severity Relapse Potential Patient Placement Criteria DIMENSIONS 1 2 3 Intoxication Biomedical Emotional Withdrawal Behavioral 4 5 6 Treatment Relapse Potential Recovery Environment Acceptance/ Resistance Decision Rules LEVEL OF CARE 1. Outpatient 2. Intensive 3. Medically 4. Medically Outpatient Monitored Managed Intensive Intensive Inpatient Inpatient