Page 103

TEAMKY Demonstration

Approval Period: January 1, 2025 through December 31, 2029

Page 102 of 155

A. GENERAL BACKGROUND INFORMATION

A.1. Purpose

Although the opioid crisis is national in scope, the Commonwealth of Kentucky has been particularly acutely affected, ranking among the top 10 states in opioid-related overdose deaths [1]. Furthermore, about 40% of adults with opioid addiction are within the Medicaid-insured population [2], and 80% of hospitalizations for neonatal abstinence syndrome in Kentucky are reimbursed by Medicaid [3].

Kentucky Medicaid proposed a Substance Use Disorder (SUD) demonstration project as part of its larger application for a Section 1115 demonstration project, "TEAMKY” (formerly KY HEALTH), to buttress its ongoing efforts to address the opioid crisis. The proposal for the 1115 SUD demonstration project was approved by the Centers for Medicare and Medicaid Services (CMS) on January 12, 2018. The implementation plan for the demonstration has been approved twice—first on October 5, 2018 [4], and most recently as part of an amended approval granted on November 28, 2018 [5].

The purpose of the SUD demonstration project is to increase access to SUD treatment services and reduce opioid-related overdose injuries and deaths. To achieve this purpose, Kentucky Medicaid will implement a plan to increase beneficiary access to SUD providers offering treatment services and expand SUD treatment benefits available to enrollees.

The central features of this demonstration are: 1. increased access to SUD providers by assessing Medicaid SUD provider capacity at critical levels of care and certifying residential treatment providers according to nationally-recognized standards for SUD treatment; 2. waiver of the Medicaid Institutions for Mental Disease (IMD) exclusion, allowing reimbursement for SUD treatment during short-term residential stays at certified IMD facilities with greater than 16 beds; and 3. expanded coverage of medication-assisted treatment (MAT) services, including methadone.

A.2. Brief Description of Demonstration and Implementation Plan

The Commonwealth of Kentucky and Kentucky Medicaid have already launched a range of SUD initiatives, and Kentucky Medicaid currently covers many services across the continuum of care for SUD, including outpatient and intensive outpatient services, partial hospitalization treatment, residential treatment, and medication-assisted treatment with buprenorphine and naltrexone.

The SUD demonstration will build on these initiatives and expand Medicaid SUD benefits to strengthen efforts to combat the opioid crisis. As described in STC 93, the key goals of the SUD demonstration are to: 1. improve access to critical levels of care for Opioid Use Disorder (OUD) and other SUDs for Medicaid beneficiaries;