Enhanced Medicaid Support for Infants, Pregnant Mothers Affected by Opioids

Addressing the opioid crisis is a top priority for the Trump Administration and the Centers for Medicare & Medicaid Services (CMS). CMS is committed to preventing and reducing opioid use disorder by promoting safe opioid prescribing and encouraging non-opioid pain treatments. Over the last several years, we have issued several Informational Bulletins outlining state approaches and effective practices for addressing the opioid overdose epidemic within Medicaid. Today, we continue that effort, by releasing two Informational Bulletins.

First, an Informational Bulletin providing clarification to states about section 1007, “Caring Recovery for Infants and Babies”, in the Substance Use-Disorder Prevention that Promoted Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act was released. This provision added a new section 1902(a)(86) to the Social Security Act (Act) to add an optional provider type of “residential pediatric recovery center” (RPRC) to Medicaid for treatment of infants with Neonatal Abstinence Syndrome (NAS) without any other significant medical risk factors. This Informational Bulletin provides information to states on how they may cover services for infants with NAS via this new provider type in their Medicaid programs. It also provides information to states on implementation of provisions in section 1007 of the SUPPORT Act that specify that RPRCs may offer counseling and other services to mothers (and other appropriate family members and caretakers) of infants receiving treatment at such centers if such services are otherwise covered under the state plan under this title or under a waiver of such plan.

A second Informational Bulletin released today to provide information to states on section 1012, “Help for Moms and Babies”, in the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, (SUPPORT) for Patients and Communities Act. Section 1012 creates a new limited exception to the institution for mental diseases (IMD) exclusion for pregnant and postpartum women with substance use disorders. Generally, Medicaid coverage is not available for services provided to beneficiaries while they reside in an IMD defined in statute as a “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases including medical attention, nursing care, and related services.” This exclusion refers to services provided to beneficiaries within the IMD setting as well as services provided outside of the IMD. Section 1012 establishes a new exception to the IMD exclusion for pregnant women who are receiving treatment in an IMD for an SUD to allow Medicaid coverage of items and services provided outside of the IMD. This Information Bulletin provides information on how states may implement this new exception to the IMD exclusion.

• Caring Recovery for Infants and Babies
• Help for Moms and Babies