91视频

The policy statement comes as Congress considers fundamentally altering Medicaid – the largest third-party payer of SUD treatment – by potentially reducing federal funding, imposing work requirements, and/or halting continuance of ACA subsidies. One of ASAM’s leading recommendations is that, instead, Congress can condition federal Medicaid payments to addiction treatment programs on adherence to nationally recognized, evidence-based, SUD-specific standards, and ensure that public and private insurance cover addiction treatment services – including medications and psychosocial care.  

“Dangerous insurance coverage gaps and low reimbursement rates have left our country ill-equipped to confront the addiction and overdose crisis,” said Stephen Taylor, MD, MPH, DFAPA, DFASAM, president of ASAM. “As it stands, our addiction treatment infrastructure is struggling to keep pace with the needs of patients, due, in part, to persistent workforce shortages. Policymakers can bolster our national response to this epidemic and save more lives by strengthening, not cutting, coverage and reimbursement for lifesaving addiction treatment services in private plans, Medicare, and Medicaid.” 

The statement further explores cost barriers and coverage restrictions that make it difficult for patients with SUD to access medically necessary care. For example, ASAM notes that “many patients are subject to prohibitive cost-sharing requirements when they receive addiction treatment,” increasing the likelihood that they will stop that treatment. Given this can contribute to poor health outcomes, ASAM also calls on lawmakers to remove cost-sharing from FDA-approved treatments, along with other measures.  

91视频 Recommendations 

To ensure that the proper financial and reimbursement infrastructure is in place to support patient access to high-quality addiction treatment services, ASAM recommends a range of actions, including: 

1. In lieu of attempts to fundamentally alter federal Medicaid financing, impose work requirements, or halt continuance of ACA subsidies, Congress takes steps to: 

   • continue to ensure that there are no duplicative payments or “fraud, waste, and abuse” found in Medicaid, as those terms are commonly understood; 

   • condition federal Medicaid payments to addiction treatment programs on adherence to nationally recognized, evidence-based, SUD-specific standards developed by a nonprofit medical association generally recognized for its expertise in addiction treatment; and 

   • ensure that private insurance, Medicaid, and Medicare cover and adequately reimburse for addiction treatment services. 

2. Payers eliminate cost sharing policies for FDA-approved / cleared pharmacotherapies and devices. 

3. Congress fully extend federal mental health and addiction parity protections under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to Medicare (including Advantage Plans), Medicaid (fee for service), CHAMPUS, CHAMPVA, and TRICARE. 

4. Congress act to incentivize access to quality SUD treatment by increasing Medicaid payment rates for SUD services to 100 percent of the Medicare rate for the same service for healthcare professionals who specialize in SUD treatment. 

Read the full statement and policy recommendations here.