CMS Gives States Medicaid Guidance for Treating Infants Affected by Opioids

CMS released guidance to states Monday about how to use Medicaid to manage infants with neonatal abstinence syndrome (NAS), as well as using health information technology such as telemedicine to combat opioid use disorder (OUD).

“The number of American infants born dependent on opioids each day is heartbreaking,” HHS Secretary Alex Azar said in a statement. “State-level innovation, including in the use of prescription drug monitoring programs and electronic health records, has been and will be a key piece of ending this crisis.”

The guidance provides information to states on the tools available to them, describes the types of approaches they can use, and ensures states know what resources are available. It also outlines promising practices for addressing the needs of beneficiaries with OUD.

In addition, CMS issued a letter to state Medicaid directors about how they may use federal funding to enhance Medicaid technology to care for those with SUD.

CMS said NAS is a rapidly growing public health concern; roughly 80% of infants treated for NAS receive their care through Medicaid.

The incidence of NAS increased nearly 5-fold between 2000 and 2012—from a rate of 1.2 per 1000 hospital births per year in 2000 to 5.8 per 1000 hospital births per year in 2012—for a total of 21,732 infants diagnosed with NAS that year.

NAS is a group of symptoms in newborn infants exposed to any of a variety of substances in utero, including opioids. Withdrawal most commonly results from exposure to opioids, but symptoms of neonatal withdrawal have also been noted in infants exposed to antidepressants, anxiolytics, and other non-opioids.

NAS treatment may occur not only in hospitals, but also in other settings. CMS also said it supports nonpharmacological care for infants like rooming in with the mother, breastfeeding, swaddling, quiet environments, little stimulation, skin-to-skin contact, and other environmental approaches, which it called critical first-line care.

Using Medicaid Funding to Enhance Technology

The opioid technology guidance advises states on which funding authorities may support new technology efforts.

There is an emphasis on using existing authority contained in the final rule called Mechanized Claims Processing and Information Retrieval Systems and in the Health Information Technology for Economic and Clinical Health, commonly referred to as the HITECH Act, which makes available a 90% enhanced funding match for state spending on activities to promote health information exchange and encourage the adoption of certified electronic health record (EHR) technology by certain Medicaid providers until 2021, if certain criteria are met.

In the case of systems supporting Medicaid Information Technology Architecture business processes, 2 options may be available for states to use; a 90% enhanced funding to design, develop, and implement systems might be available with a 75% enhanced match available for the maintenance and operation of such systems.

The guidance falls in line with the President’s Commission on Combating Drug Addiction and the Opioid Crisis released last year, which highlights telemedicine and prescription monitoring tools. States may access enhanced federal funding to integrate innovative substance abuse treatment in areas facing provider shortages, such as rural areas. Options include virtual treatment centers or remote counseling.

Federal funding could also be used for shared electronic care plans and could complement medication assisted therapy, patient apps, and remote monitoring technology.

In addition, states are encouraged to reduce provider burden by creating a single sign-on interoperability between EHRs and prescription drug monitoring programs (PDMPs), allowing physicians to e-prescribe in the same platform where EHRs are held.

Integrating EHRs and PDMPs removes the requirement for healthcare providers to log in to a separate system, manage a separate log in, and disrupt their workflow to query the PDMP, CMS said.