HJAR Nov/Dec 2020

42 NOV / DEC 2020 I  HEALTHCARE JOURNAL OF ARKANSAS MEDICAID COLUMN MEDICAID INACCORDANCE withArkansas Act 964 of 2019 and best practices issued by the Sub- stanceAbuse andMental Health ServicesAd- ministration (SAMHSA), the Arkansas Med- icaid program has instituted policy changes that make Medication-Assisted Treatment (MAT) for Opioid Use Disorder (OUD) eas- ier to access. As of Sept. 1, 2020, all aspects of Medicaid’s new MAT policy are in effect, andArkansas Medicaid needs more enrolled providers to offer this treatment to eligible clients. Opioid Prescription Rate Led to Declaration of Emergency In light of the high opioid prescription rate inArkansas (102.1 prescriptions per 100 people, compared to the national average of 58.7), theArkansas Medicaid pharmacy pro- gram implemented numerous changes over the years to decrease or limit opioid drug claims. These edits included switching the types of opioids being prescribed; decreasing the daily Morphine Milligram Equivalents (MME) to 90 MME per day; and implement- ing “refill too soon”edits, accumulation limi- tations and quantity limits for “new starts” to an opioid. Despite these limitations on opioids in the Medicaid program, OUD and the of substance use disorders. Research has shown that a combination of medication and therapy can successfully treat substance use disorders, and for some people strug- gling with addiction, MAT can help sustain recovery. For individuals with OUD specifi- cally, MAT has proven to be clinically effec- tive and to significantly reduce the need for inpatient detoxification services. MAT pro- vides a comprehensive, individually tailored programof medication, medical services, and behavioral therapy that addresses the needs of most patients. The ultimate goal of MAT is full recovery. This treatment approach has been shown to: • Improve patient survival. • Increase retention in treatment. • Decrease illicit opiate use and other criminal activity among people with substance use disorders. • Increase patients’ ability to gain and maintain employment. • Improve birth outcomes among preg- nant women who have substance use disorders. Research also shows that MAT can contrib- ute to lowering a person’s risk of contracting HIV or Hepatitis C by reducing the potential for relapse. Arkansas Medicaid Reduces Barriers to Access Medication-Assisted Treatment for Opioid Use Disorder accompanying harms continued to plague the program and the state at large until the Arkansas legislature declared an emergency through Act 964 of 2019, finding that: • MAT is effective at treating opioid ad- diction and results in substantial cost savings. • Some healthcare insurers, including Medicaid, were placing numerous prior authorization requirements on health- care providers and their patients in need of MAT. • As a result of these counterproductive requirements, patients were resorting to continued illegal drug use to stop withdrawals, and physicians may have been deterred from treating patients due to the difficult prior authorization requirements. Act 964 prohibits the imposition of any requirement other than a valid prescription and compliance with MAT guidelines issued by SAMHSA for a Medicaid client with a di- agnosis of OUD to obtain coverage of MAT. MAT: A “Whole Patient” Approach SAMHSA defines MAT as the use of medications in combination with counsel- ing and behavioral therapies to provide a “whole patient” approach for the treatment Janet Mann Director Division of Medical Services Arkansas Medicaid