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TEAMKY Demonstration

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

Page 117 of 155 collection will occur yearly in order to monitor changes in each year of the program, with the first data collection period anticipated to occur around March 2020-May 2020.

Throughout the duration of the SUD waiver, we will conduct a mix of longitudinal cohort interviews, with the initially-identified population, and one-time interviews, in order to represent a variety of experiences. That is, we anticipate primarily a cross-sectional design, with a smaller longitudinal cohort.

For the first cohort, we plan to recruit participants from three sources. We will contact beneficiaries identified through the 2018 beneficiary survey whose responses were reflective of a possible substance use disorder, recruit from treatment facilities offering methadone for MAT, and recruit from inpatient facilities expanding access through the lifting of the IMD exclusion. For subsequent cohorts, we will recruit from treatment facilities, as well as consider other direct recruitment options based on the makeup of our sample; for example, we may recruit from non- treatment facilities such as primary care facilities to capture the experience of people not engaged in active treatment.

Thematic analysis will be done with multiple trained coders to identify themes throughout the interviews, and mixed-methods analysis will be performed, using the qualitative interviews to further explain and elucidate results from the quantitative data.

As the evaluation progresses and interviews are analyzed, the Penn team will evaluate the need for additional qualitative interviews to cover any areas where more experiences should be captured. This could include beneficiaries experiencing barriers to treatment or the addition of provider interviews as needed.

C.5.3. Cost (expenditure) analyses Pursuant to CMS requirements for all SUD section 1115 demonstrations, we will be conducting analyses of costs (expenditures) associated with the Kentucky SUD demonstration. The econometric structure of these analyses will be the same as those outlined in section C.5.1 (Quantitative analyses), using descriptive summary statistics and the interrupted time series without comparison group method to evaluate the effect of the demonstration on expenditures.

Because almost all Kentucky Medicaid beneficiaries are enrolled in managed care plans and because data on negotiated capitated payments will not be available for this analysis, we will be using data on encounters reported by Medicaid managed care organizations (MCOs) and compiled by the Kentucky Cabinet for Health and Family Services. As described in Section C.4 (Data sources), these data provide information on health care services provided to beneficiaries and information on payments made to providers by MCOs for these services. Although these data do not reflect contemporaneous costs incurred by Medicaid for care provided to beneficiaries— because Medicaid pays a capitated rate to the MCOs—they are used by the state Medicaid program, in combination with other factors, to determine capitated MCO rates. For this reason, they can provide a useful if imperfect measure of costs incurred by the Medicaid program.

Following CMS recommendations, we will be conducting analyses at three different levels: