适应不断发展的标准：更新国家政策和报销率，以符合最新的ASAM标准

Adapting toevolvingstandards:Updatingstatepoliciesandreimbursement ratestoalignwith thelatestASAM Criteria David Applegate,MPPJessica Bertolo,MBAJeremy Cunningham, FSA, MAAAKelsey Hiegel, MPA Madison Hybels, JDAli Marzolf, MPPAmanda Schipp, JD The American Society of Addiction Medicine (ASAM)Criteriaisthewidelyacknowledged standardfor addiction treatmentacross the United States.ASAMreleasedanupdatededition of theCriteria foraddiction treatment servicesinlate2023.This paper exploresconsiderations for stateagencies(e.g., Medicaid, Health,Insurance)consideringtheupdatedASAMCriteriaand potential future updates. TheupdatedplacementCriteria for addiction services, releasedby ASAMinfall2023, marksthe first significant update to theASAM Criteria in10years. The Centers for Medicare andMedicaid Services (CMS)haslong required state Medicaidagencies expanding substance use disorder (SUD) services toalign withtheASAM Criteria. Consequently, state agencieswillneed to reviewpotential impacts to theirpolicies andprocedures to ensure alignment with the latest edition, includingpossible budgetary implications dueto provider reimbursementrate adjustments. state agencies, anddiscusses strategies state agencies might usetoproactively addresspossiblechallenges as they navigatecurrentandforthcoming updatesto theCriteria.We anticipatemanystateswillneed torevisetheircurrentpolicies and procedures toensurealignmentwith the updatedASAM Criteria,as well as update thecorresponding reimbursement rates associated with each ASAMlevel of care to reflect new providerstaffing and servicerequirements.Further, asadditionalupdatesto the ASAM Criteriaareexpected to bereleased in the coming years, statesmay find itbeneficial todevelopa strategic frameworkand process forregularlyreviewing and updatingSUD and addiction treatmentpoliciesand provider reimbursement rates.1 States should consider a comprehensive review of statutes,regulations, administrative codes, Medicaid waivers, and otherpolicies that incorporate or reference the ASAM Criteria. The goalis to ensure state policies and protocols remain consistent with theupdated ASAM Criteria and reflect current best practices for SUDand addiction treatment. Additionally, statesmight considerevaluatingwhether changes in SUD reimbursement rates arenecessary to align with policy changes(including increased staffingrequirements).This white paperprovides ahigh-leveloverviewofkey changes to the ASAM Criteria,notespotential implications for History of ASAMandadoptionasbest practice The American Society of AddictionMedicine is a privatenonprofit professional association that represents healthcareprofessionals working in addiction medicine.2In 1991,theorganizationintroduced the influential ASAM Criteria, a set ofguidelines for addiction treatment placementthat emphasizes the importance of treatment plans specifically tailoredto theneeds of individual patients.3Sinceitsintroduction, theASAMCriteria has been adopted by over 30 states and endorsed byCMS.4The ASAM Criteria’s status as an industry standardwasfurther signaled byCMSwhen that organization requiredalignment with ASAMfor statesseeking approval ofSUDMedicaid1115 demonstration waiversto provide services ininstitutions for mental disease (IMDs)and the “use of nationallyrecognized, evidence-based SUD program standards to setresidential treatment provider qualifications.”5,6 THE CONTINUUM OF CARE Therevised Criteriaaims to streamline and align the continuumof care to what is available in communities across the country.Asshown in Figure1, this includesupdating the levels of carecurrently included (i.e.,expanding and separating a level intomultiple levelsandremoving levels altogether), integratingwithdrawal management into the continuum of care, updatinglevels to reflect residential settings, andpromoting improvedcontinuity of care along thecontinuum.Updates to the level ofcarecriteriainclude separating and expanding levelsin severalways, as highlighted below. ASAMCriteriaupdates Early intervention:Thefourthedition of the ASAM Criteriareframes the terminology used around early intervention andprevention. While early intervention and prevention are stillrecognized as key components of responding to addiction,these activities typically occur outside of a treatment setting.Consequently, thefourthedition no longer uses Level 0.5,and these activities are discussed separately from the levelsof care. Thefourth editionof the ASAM Criteria,released inlate fall 2023,represents the first major revision since thethird edition’sreleasein 2013—more than a decade ago.Updates to the Criteriaincludemajorchangesinassessment and treatment planningstandardsandservice requirements across thecontinuum ofcare,with other minor updates addressed.7 THE ASAM CRITERIA ASSESSMENT AND TREATMENTPLANNING STANDARDS Outpatientlevel of care (LOC):Long-term RemissionMonitoring (Level 1.0) was expanded to include moredetailed standards for the care that occurs at this level. T