Many people who experience opioid use disorder rely on Medicaid. The high penetration of managed care systems into Medicaid raises the importance of understanding states’ expectations regarding coverage, access to care, and health system performance and effectively elevates agreements between states and plans into blueprints for coverage and care. Federal law broadly regulates these structured agreements while leaving a high degree of discretion to states and plans. In this study, researchers reviewed the provisions of 15 state Medicaid managed care contract related to substance use disorder (SUD) treatment to identify whether certain elements of SUD treatment were a stated expectation and the extent to which the details of those expectations varied across states in ways that ultimately could affect evaluation of performance and health outcomes. We found that while all states include SUD treatment as a stated contract expectation, discussions around coverage of specific services and nationally recognized guidelines varied. These variations reflect key state choices regarding how much deference to afford their plans in coverage design and plan administration and reveal important differences in purchasing expectations that could carry implications for efforts to examine similarities and differences in access, quality, and health outcomes within managed care across the states.

中文翻译：

---

医疗补助管理式医疗如何满足阿片类药物使用障碍受益人的需求？深入探讨合同设计

许多患有阿片类药物使用障碍的人依赖医疗补助。管理式医疗系统在医疗补助中的高度渗透提高了了解各州对覆盖范围、获得医疗服务和卫生系统绩效的期望的重要性，并有效地将各州之间的协议和计划提升为覆盖和医疗的蓝图。联邦法律广泛规范这些结构性协议，同时给各州和计划留下高度的自由裁量权。在这项研究中，研究人员审查了 15 个州医疗补助管理式医疗合同中与物质使用障碍 (SUD) 治疗相关的条款，以确定 SUD 治疗的某些要素是否是既定期望，以及这些期望的细节在各州之间存在差异的程度。最终可能影响绩效评估和健康结果的方式。我们发现，虽然所有州都将 SUD 待遇作为规定的合同期望，但围绕特定服务覆盖范围和国家认可指南的讨论各不相同。这些差异反映了各州在承保范围设计和计划管理方面对计划给予多少尊重的关键选择，并揭示了购买预期的重要差异，这可能会对检查不同地区的管理式医疗中的获取、质量和健康结果的相似性和差异的努力产生影响。美国。