Caitlin Thomas-Henkel, MSWApril 4, 2019
In 2018, over 3,000 New Jersey residents are believed to have died from drug overdose, and suicides among 10- to 18-year-olds in the state have increased by nearly 50 percent over the past decade. With Medicaid covering four in 10 nonelderly adults with opioid use disorder (OUD) nationally, states can play a pivotal role in building a continuum of care for people with OUD and other types of substance use disorder (SUD).
In January 2019, New Jersey announced a multi-faceted OUD strategy that includes enhanced Medicaid reimbursement for providing medication-assisted treatment (MAT) through an office-based addiction treatment (OBAT) model and the establishment of Centers of Excellence to support community-based clinicians providing addiction treatment. Carole Johnson, Commissioner of New Jersey’s Department of Human Services, is leading the state’s efforts focused on best practices, robust stakeholder engagement, and cross-agency collaboration.
With support from the Robert Wood Johnson Foundation, the Center for Health Care Strategies is providing technical assistance to New Jersey in support of activities to improve health outcomes for Medicaid beneficiaries. CHCS recently spoke with Commissioner Johnson to learn about New Jersey’s strategies to combat the opioid epidemic.
Q: Why did the state choose to develop an OBAT model?
A: Governor Murphy has made combatting the opioid epidemic an all-hands-on-deck fight in our state. As a new Administration, we looked with fresh eyes at where we were with our response tools. We knew that we had made important changes with our SUD Medicaid waiver for inpatient treatment, but that we needed to do more to build up our outpatient, community-based treatment capacity. That is how we came to our office-based addiction treatment model as a way to align incentives for primary care providers to not only get waivered to provide MAT for opioid use disorder, but to provide MAT in their practices across our state.
Q: This effort involved a number of state agencies working together to design the model. What have you learned about enabling these collaborations to happen and how has it paid off?
A: We were fortunate to have two things occur around the same time as we were looking to build this model. First, the Governor proposed and secured new funding in our state budget to combat the opioid epidemic. We are using our share of this funding for OBAT and a number of other prevention, treatment, and recovery strategies. But, this is really a whole-of-government response, where everyone from our Department’s Medicaid team and our mental health and addiction division to the Departments of Labor, Health and Corrections are working together. The second critical step that helped us advance the OBAT model quickly was the Governor’s action to return our Division of Mental Health and Addiction Services to the Department of Human Services, where it could be under the same roof as our Medicaid program. By having all of our clinical, payment, and intervention experts around the same table, we were able to solve problems quickly and move forward with the speed this epidemic demands. So, the Governor gave us both the resources and the structure we needed, and we are running with it.
Q: The state conducted a series of external stakeholder convenings to inform the design of the OBAT model. Who was included in these meetings, why was it important to include these stakeholders, and what feedback was most helpful?
We have continually expanded our table to bring in our community health centers, our certified community behavioral health clinics, academic medical centers, the managed care organizations’ medical and operations leaders — everyone who can help us realize our goal of broad-based access to opioid use disorder treatment.
A: We could not have gotten this effort off the ground without the input of leaders from the provider, payer, and advocacy communities. Early on, we were particularly anxious to hear from community-based primary care physicians who were providing MAT in order to understand what motivated them and how we might translate that to others. We have continually expanded our table to bring in our community health centers, our certified community behavioral health clinics, academic medical centers, the managed care organizations’ medical and operations leaders — everyone who can help us realize our goal of broad-based access to opioid use disorder treatment. All of these voices matter, and we are grateful for their shared commitment to this work.
Q: Providers often cite prior authorization (PA) as a barrier to accessing MAT for opioid use disorder. The state recently announced it would be lifting PA for a number of medications used to treat OUD and other SUDs. Can you describe the new requirements, how you came to select these new guidelines, and the plan for sharing these policy changes with providers and consumers?
We simply determined that prior authorization ran counter to our goal of ensuring that individuals with opioid use disorder get timely treatment. When someone is ready, we shouldn’t be losing them to care while they wait for approval.
A: Because of our policy change, as of Monday, April 1, 2019, Medicaid plans in New Jersey no longer require prior authorization for MAT for opioid use disorder. This is a critical step for us because about 95 percent of our Medicaid population is in a managed care plan. We simply determined that prior authorization ran counter to our goal of ensuring that individuals with opioid use disorder get timely treatment. When someone is ready, we shouldn’t be losing them to care while they wait for approval. The plans have worked with us to get this change implemented quickly, and we hope it will make a meaningful difference in terms of access. We also hope that it will encourage more providers to offer MAT because we know that prior authorization policies have been a factor in provider willingness to offer MAT.
Q: Are there plans to implement additional services in the future?
A: We are excited to get our OBAT effort underway, and our short-term focus is on provider take-up. We’ve funded training for new MAT providers, and have stood up Centers of Excellence to provide the support, mentoring, and referral network that providers told us they needed to help them take on this OBAT work. We’ve also changed our Medicaid rates to enhance provider payment and reimburse for navigator services to coordinate the counseling and social services supports an individual with OUD needs. Going forward, we’ll build and adjust as we learn. We’ll also look for additional ways to get MAT to individuals with OUD as quickly as possible. It is important for us to continue to build so that there is simply no wrong door when someone is ready to seek treatment.
Q: What advice would you give other states interested in pursuing this work?
We still have a lot to learn, but we are learning while building because we feel the urgency of the need.
A: Go for it. There is an opioid crisis outside all of our doors, there is federal money on the table for treatment, and there are physician and advanced practice nurse champions who can help inform your efforts. We still have a lot to learn, but we are learning while building because we feel the urgency of the need. We are grateful to the other states who helped us along the way.