Abstract：
Managed care plans, which contract with states to cover three-quarters of Medicaid enrollees, play a crucial role in addressing the drug epidemic in the United States. However, substance use disorder benefits vary across Medicaid managed care plans, and it is unclear what role states play in regulating their activities. To address this question, we surveyed thirty-three states and Washington, D.C., regarding their substance use disorder treatment coverage and utilization management requirements for Medicaid managed care plans in 2021. Most states mandated coverage of common forms of substance use disorder treatment and prohibited annual maximums and enrollee cost sharing in managed care. Fewer than one-third of states forbade managed care plans from imposing prior authorization for each treatment service. For most treatment medications, fewer than two-thirds of states prohibited prior authorization, drug testing, \"fail first,\" or psychosocial therapy requirements in managed care. Our findings suggest that many states give managed care plans broad discretion to impose requirements on covered substance use disorder treatments, which may affect access to lifesaving care.
摘要：
托管护理计划，与各州签订合同，覆盖四分之三的医疗补助参保人，在解决美国的毒品流行方面发挥着至关重要的作用。然而,药物使用障碍的福利因医疗补助管理式护理计划而异，目前尚不清楚国家在调节其活动中扮演什么角色。为了解决这个问题，我们调查了33个州和华盛顿州，D.C.,关于2021年医疗补助管理式护理计划的物质使用障碍治疗覆盖率和利用管理要求。大多数州都要求覆盖常见形式的物质使用障碍治疗，并禁止在管理式护理中每年最高限额和注册费用分摊。不到三分之一的州禁止管理式护理计划对每项治疗服务进行事先授权。对于大多数治疗药物，不到三分之二的州禁止事先授权，药物测试,\"首先失败,“或管理式护理中的社会心理治疗要求。我们的研究结果表明，许多州给予管理式护理计划广泛的自由裁量权，对承保的物质使用障碍治疗施加要求，这可能会影响获得救生护理。
