The CMS on Monday revealed new coverage options that state Medicaid programs can use to help moms and babies affected by opioid use disorder.
In two informational bulletins, the agency clarified provisions included in the Support for Patients and Communities Act, a package of legislation signed into law in October to combat the opioid epidemic, that addresses treatment for pregnant and postpartum women with substance use disorder and for babies with neonatal abstinence syndrome.
"The opioid epidemic has affected the entire country, but the impact on babies is one of the most tragic consequences of this public health crisis," said Kimberly Brandt, CMS' principal deputy administrator for operations and policy. "Our comprehensive efforts to combat the opioid epidemic include a laser focus on the needs of vulnerable populations."
Under the Support Act, state Medicaid programs may now choose to pay for services such as assessments, development of care plans, swaddling, feeding and specialized care for infants at residential pediatric recovery centers. The law defined the centers as facilities that treat babies with neonatal abstinence syndrome, the CMS explained in one of the bulletins. These recovery centers care for babies who are well enough to leave the hospital but not yet ready to go home.
The recovery centers may also provide counseling and training to mothers and other caretakers, even if they are not eligible for Medicaid, as long as the services benefit the baby's treatment and health. States have significant flexibility in how they pay for the benefits at these recovery centers, and can pay for them individually or bundled, the CMS said.
The CMS in the second bulletin encouraged all states to implement as quickly as possible a new exception to the so-called IMD exclusion that frees up Medicaid funds to provide certain services to pregnant women and postpartum mothers with substance use disorder who are residing in institutions for mental disease. States have until Oct. 1, 2020, to implement the exception, the agency said.
In general, Medicaid was banned from paying for treatment at IMDs for anyone between ages 21 and 64. But the Support Act allows Medicaid to pay for services typically covered outside of an IMD to eligible pregnant women and postpartum moms, such as prenatal services, the CMS said.
