In 2019, the Washington legislature enacted a bill requiring insurers on the state’s health insurance exchange to offer plans with standardized benefit designs, beginning in 2021. Colorado and Maryland are considering similar requirements. As these and other states consider the option of standardized health plans, they can benefit from the experiences of California, the District of Columbia (D.C.), Connecticut, Massachusetts, New York, Oregon, and Vermont, all of which require insurers to offer standardized benefit designs. This Expert Perspective outlines benefits and risks of plan standardization, and raises critical questions that states will need to consider, and offers a decision roadmap for states implementing a standardized benefit design requirement.
Implementing the ASAM Criteria for SUD Treatment through Medicaid Managed Care
Rachel Isaacson, Ellie Shea-Delaney and Beth Waldman, Bailit Health
As the opioid epidemic continues, Medicaid programs across the country are increasingly taking on more responsibility to provide beneficiaries with substance use disorder (SUD) treatment, including inpatient treatment. One strategy states are using is applying for an SUD Section 1115 Demonstration waiver (SUD waiver) from the Centers for Medicare & Medicaid Services (CMS) to expand Medicaid-funded treatment options. Some states with approved SUD waivers have formally implemented the American Society for Addiction Medicine (ASAM) Criteria to promote consistency in client placement for SUD treatment.
The ASAM Criteria is a clinically driven multidimensional client assessment model that emphasizes treatment outcomes, client-specific lengths of service, and a team-based approach to care. This issue brief draws from the experiences of states that were among the first to implement their SUD waivers to profile how the ASAM Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.