AIS Health: MOM Model Allows States, MCOs to Address Care Barriers

MOM Model Allows States, MCOs to Address Care Barriers

Reprinted with AIS Health’s permission from the November 1, 2018, issue of Radar on Medicare Advantage

Medicaid managed care organizations will soon have a new opportunity to address the growing and costly burden of maternal opioid misuse. Just a day before President Trump signed a sweeping package of bills addressing the opioid epidemic, CMS on Oct. 23 unveiled the Maternal Opioid Misuse (MOM) model. Under that program, the Innovation Center will award up to 12 cooperative agreements with states, whose Medicaid agencies will implement the model with one or more “care-delivery partners” in their communities, including health plans.

Jennifer Moore, Ph.D., executive director of the Institute for Medicaid Innovation, says the new initiative is very much in line with what the nonprofit research organization has been advocating for through its various reports. “In addition to the Integrated Care for Kids model that CMS had released in August…both initiatives sent a strong message that CMS is committed to the issues around opioid use in pregnant women” and in children, she tells AIS Health.

Model Aims to Improve Coordination

In a fact sheet unveiling the model, CMS said it is intended to “address fragmentation in the care of pregnant and post-partum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system surrounding this vulnerable population” and to ensure that mothers with OUD receive a comprehensive set of services delivered in a coordinated and integrated fashion.

Not only has there been a surge in recent years in substance-use related illness and death among pregnant and postpartum women, but the number of babies born with neonatal abstinence syndrome (NAS) — an opioid withdrawal syndrome that can lead to lengthy and costly hospital stays — jumped 300% between 1999 and 2013 in 28 states with publicly available data on opioid addiction. And Medicaid pays the largest portion of hospital charges for maternal substance use, as well as the bulk of the $1.5 billion annual cost of NAS, according to CMS.

Yet despite this significant impact, opioid-addicted pregnant women face various barriers to treatment, such as a lack of comprehensive services during pregnancy and the postpartum period, fragmented systems of care and a shortage of maternity care and substance use treatment providers, observed CMS.

The MOM model will award cooperative agreements to states to support Medicaid agencies, providers and health systems to address this fragmentation of care. The state will be expected to complete the application, which must demonstrate that it has teamed up with at least one care-delivery partner, which could be a health system or payer, suggested CMS. State Medicaid agencies will develop and implement coverage and payment strategies, while their partners will provide services to beneficiaries. The responsibilities of such partners are:

  • Establishing relationships with clinical partners;
  • Building capacity at the service level to support care-delivery transformation; and
  • Implementing a coordinated and integrated care-delivery approach.

A maximum of $64.6 million will be distributed among up to 12 state awardees over a five-year period. To support the model’s goals, the Innovation Center will provide funding in phases to cover three areas: implementation, transition and milestone. CMS noted that model funding may not be used to supplant or duplicate Medicaid-funded services.

Although it’s too early to predict what states will apply for the grants, Moore says she thinks health plans will be on board. “I think everyone, regardless of what their role is in Medicaid or their policy position, is eager to participate in an initiative, especially one that has support behind it, to address this growing epidemic,” she remarks.

CMS said it expects to release a Notice of Funding Opportunity in early 2019 to solicit cooperative agreement applications.

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by Lauren Flynn Kelly

Article from AIS Health