Substance Use Disorder Providers and Insurance Reimbursement

Behavioral Health

Improving access to substance use disorder treatment in the US

With funding from ASPE, we’re examining and documenting state policies and strategies around substance use disorder treatment—including provider licensing and credentialing requirements, reimbursements for services, and the innovative methods some states are using to expand their provider networks.

Impact

Ultimately, the federal government aims to provide tailored technical assistance to help states expand provider networks and increase access to substance use disorder treatment.

Services
  • Environmental Scan
  • Data Collection and Analysis
  • Qualitative Data Analysis

A growing gap for services

There’s an urgent need to make appropriate treatment for substance use disorders more widely available in the US: According to SAMHSA’s 2015 National Survey on Drug Use and Health, 21.7 million people aged 12 or older needed treatment for substance use disorder (SUD) in the past year, but only 14% received treatment, and only 8.1% received that treatment at a specialty facility. And, given the opioid epidemic, that gap has likely grown.

Examining system barriers to treatment

An individual’s situation and lifestyle may influence whether they seek treatment, but characteristics of the healthcare system itself can also affect whether people seek and obtain treatment. These can include complex eligibility and admission criteria, the absence of appropriate services for certain cultural groups, and a lack of available treatment providers.

Financial support for treatment services can be another major barrier. Although insurance coverage for treatment has become more widespread in recent years, SUD treatment providers have historically relied on grant funding more than on insurance reimbursement. Changing that requires a different set of policies and procedures. And treatment providers will need assistance to navigate the requirements and processes for joining insurance provider networks—including credentialing, billing, and more—especially at a time when treatment and recovery systems are overwhelmed by demand.

Scanning for best practices

Across the nation, state Medicaid agencies, their managed care organizations, and commercial insurers have developed a range of policies, programs, and reimbursement strategies to address the need for services, including those related to:

  • Eligibility
  • Benefits and services
  • Provider qualifications
  • Financing (rates, premiums, and value-based purchasing)

We’re examining this variation to uncover standout practices that are helping to expand access to providers and treatment. In addition to examining existing literature, we’re also gathering data from all 50 states and D.C. regarding their licensing and credentialing requirements for providers and insurance reimbursement policies for Medicaid and Medicare, as well as commercial insurers’ policies. We’re also interviewing national experts in the field for additional insights on barriers to treatment access and innovative strategies to address them. 

Client(s):

Assistant Secretary for Planning and Evaluation (ASPE)

Project Partner(s):

Technical Assistance Collaborative

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