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Methadone Treatment for Opioid Use Disorder Improving Access Through Regulatory and Legal Change: Proceedings of a Workshop (2022) / Chapter Skim
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8 Ensuring Equitable Access to Methadone by Removing Current Barriers and Providing Incentives
Pages 89-96

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From page 89...
... . • A carrots-and-sticks approach by the federal government could promote access to quality methadone treatment by relaxing requirements (the sticks)
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From page 90...
... Matthew Lawrence, associate professor of law at Emory University School of Law, added that the federal government has tools that could be used to promote access to quality methadone treatment. He and Davis both suggested regulatory changes that could help achieve this goal.
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From page 91...
... While SAMHSA has proposed to extend the take-home flexibility after the COVID public health emergency ends, Davis noted that these extensions are currently slated to come with onerous requirements, such as total adherence to a treatment plan and negative toxicology tests for 60 days. Moreover, he said, none of these restrictions are required by law.
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From page 92...
... Davis suggested that flexibilities could be extended by tying them to the opioid emergency declaration that has been in place since October 2017, similar to how they are currently tied to the COVID-19 emergency declaration. Both DEA and SAMHSA have the authority to grant exemptions to many methadone regulations and nearly unlimited enforcement discretion, he said, and they could relax enforcement immediately.
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From page 93...
... Department of Health and Human Services; OTP = opioid treatment program; SAMHSA = Substance Abuse and Mental Health Services Administration; SNF = skilled nursing facility. SOURCE: Presented by Matthew Lawrence, March 4, 2022.
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From page 94...
... Employer-sponsored insurance plans are required by federal law -- the Mental Health Parity and Addiction Equity Act of 2008 and amendments to the Affordable Care Act -- to provide benefits for mental health or substance use disorder that are similar to medical and surgical benefits. However, Lawrence said enforcement of this law by the Department of Labor has been limited and there are reports of employer group plans wrongly denying coverage for methadone.
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From page 95...
... Horizontal fragmentation could also be simplified by pooling authorities, said Lawrence. • Vertical fragmentation might be addressed by having federal authorities encourage state alignment, for example, by having CMS issue a guidance and invite states to apply for waivers to test dif ferent models for providing methadone to patients.
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From page 96...
... . • Simplifying horizontal fragmentation by pooling authorities (e.g., the Drug Enforcement Administration could deputize the Center for Medicare and Medicaid Innovation by waiving all providers participating in payment model tests or consider nationwide payment model expansions)
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Key Terms

  • promote access
  • current barriers
  • quality methadone
  • horizontal fragmentation
  • regulatory environment

  • opioid treatment
  • payment models
  • methadone access
  • methadone regulations
  • provide methadone

  • encourage state
  • authority granted
  • controlled substances
  • substances act
  • treatment programs

  • medicare advantage
  • permit otps
  • initial doses
  • state alignment
  • payment model

  • medicaid innovation
  • regulatory changes
  • medicaid services
  • broad authority
  • suggested regulatory

  • substance abuse
  • emory university
  • federal administrative
  • davis suggested
  • methadone regulation


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