1. Transforming the Delivery of Substance Use Disorder Treatment in States
Update August 2019

2. Drug-related Deaths (2017)
National: 70,237
Historical Trends ( )
Legend
16 to 156
660 to 1,030
156 to 361
1,030 to 1,587
361 to 660
1,587 to 5,388
The total number of deaths from drug poisoning, including both illicit and prescription drugs.
Data Source: Centers for Disease Control and Prevention
Source: amfAR. Opioid & Health Indicators Database. Accessed August 13, 2019.

3. ASAM ADVOCACY
Teach It
Standardize It
Cover It

4. Teach It
Teach addiction medicine by expanding and strengthening our workforce and dispelling stigma

5. Teach It
States are using federal and state funds to deliver high-quality, competency-based addiction medicine education

6. Teach It +
Ohio
New York
Kentucky

7. Teach It
Louisiana
Alabama
Indiana
Kentucky
Alaska

8. Standardize It
Standardize the delivery of addiction medicine so that more patients receive high-quality, evidence-based care

9. State Treatment Program Licensure Regulations:
Standardize It
State Treatment Program Licensure Regulations:
Do they require the use of a multidimensional patient assessment?
What are the clinical decision rules being used by clinicians for an accurate level of care recommendation?
Are the treatment program licensure standards according to nationally-recognized levels of care?
And are those components part of one ecosystem developed by experts and based on research?

10. Standardize It
The ASAM Criteria® provides the ecosystem that can help a state answer these questions, serve as a roadmap to design regulations, and transform the delivery of SUD treatment in states.

11. Standardize It
Implementation of The ASAM Criteria® can improve the addiction treatment system, but only if it is implemented comprehensively and effectively

12. Standardize It ASAM Levels of Care
Service Characteristics of ASAM Level of Care Addiction Treatment Program Standards

13. ASAM Level of Care 3.5 at a Glance
Support Systems
Consultation with physician, physician assistant or nurse practitioner
Emergency services 24/7
Direct affiliation or coordination with other levels of care
Arranged medical, psychiatric, psychological, laboratory, and toxicology services
Therapies
Daily clinical services to improve patient’s ability to structure and organize the tasks of daily living and recovery
Counseling and clinical monitoring
Individual and group evidence-based cognitive, behavioral, and other therapies
Addiction pharmacotherapy
Monitoring of patient’s adherence in taking any prescribed medications
Assessment/Treatment Plan Review
Biopsychosocial assessment of patient’s substance use disorder conducted by staff who are knowledgeable about addiction treatment
Biopsychosocial assessment and treatment plan updates
Physical examination
Staff
Licensed or credentialed clinical staff such as addiction counselors, social workers, and licensed professional counselors
Allied health professional staff, on-site 24 hours
One or more clinicians with competence in the treatment of substance use disorders, available 24 hours

14. Standardize It CMS 1115 SUD Waiver Guidance (November 1, 2017):
Demonstrate standardized assessment tool
Demonstrate standardized delivery system, including residential treatment provider qualifications

16. Standardize It ASAM Level of Care Certification
Partnership between ASAM and CARF.
The ASAM Criteria® is nation’s most widely used and comprehensive set of guidelines for addiction treatment, but there is currently no verification of its implementation.
Accurately differentiate between levels of care to help patients and payers alike.
Highlight treatment programs that have evidence-based policies and procedures.

19. Cover It
Cover addiction medicine in a way that expands patient access to coordinated, comprehensive care

20. Cover It
Virginia’s Addiction and Recovery Treatment Services Program (ARTS)
Implemented in 2017 to increase access to treatment for Medicaid members with opioid use disorders (OUD) and substance use disorder (SUD).
ARTS benefits are based on the ASAM Criteria and
cover a full spectrum of addiction treatment services.
ARTS services include inpatient withdrawal
management, residential treatment, partial hospitalization, intensive outpatient programs,
opioid treatment, peer recovery, and case management. They are carved into existing
Medicaid managed care plans to support full integration of behavioral and physical health.

21. Cover It Parity at the State Level
State efforts to fully implement and enforce the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
Parity issues specific to addiction treatment:
Coverage of medications to treat SUD without utilization controls like prior authorization and step therapy.
Coverage on the lowest tier of insurers’ drug formularies.
Tying medical necessity criteria to The ASAM Criteria.

22. Cover It
At least four states have passed state legislation codifying a requirement that payers use The ASAM Criteria to make medical necessity decisions/coverage determinations:
Connecticut
Delaware
Illinois
Rhode Island

23. Multidimensional Assessment
Implements Hundreds of ASAM Decision Rules
Multidimensional Assessment
Readiness &
Screening
Diagnosis
Severity
Relapse Potential
Patient Placement Criteria
DIMENSIONS 1 2 3
Intoxication
Biomedical
Emotional
Withdrawal
Behavioral 4 5 6
Treatment
Relapse Potential
Recovery Environment
Acceptance/
Resistance
Decision Rules
LEVEL OF CARE
1. Outpatient
2. Intensive
3. Medically
4. Medically
Outpatient
Monitored
Managed
Intensive
Intensive
Inpatient
Inpatient