Issue Briefs | Nov 21, 2019

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.