Earlier this month, the GAO issued a report, Federal Action Needed to Address Neonatal Abstinence Syndrome. The GAO report was the result of a House bill included in last year’s CARA Act passed last year.  The GAO’s conclusion:

“The rising opioid crisis has caused a significant increase in the number of infants born and diagnosed with NAS…The increase in infants born with NAS also increases medical and other treatment costs experienced by the federal government and states. HHS recently published a strategy with key recommendations that have the potential to address some of the challenges related to treating NAS. However, HHS lacks a sound plan for implementing these recommendations. The absence of such planning raises questions about whether and when HHS will be able to implement these recommendations in a timely manner and be able to assess its progress.”

According to the report NAS increased from a rate of 1.2 per 1,000 hospital births per year in 2000 to 5.8 per 1,000 in 2012, reaching 21,732 infants diagnosed with NAS.  The research noted that by 2012 one infant was born about every 25 minutes with NAS.

Of significance, especially considering this year’s debates over the fate of Medicaid, more than 80 percent of NAS cases are paid for by Medicaid.  Most of the treatment to these infants is in the hospital but there is some limited outpatient clinic programs and neonatal withdrawal centers. Medicaid pays for NAS treatment services provided in the non-hospital settings, GAO reports that according to CMS officials and other stakeholders, states generally pay for these services separately, in contrast with the single bundled payment paid to hospitals.

Examples include a neonatal withdrawal center in West Virginia that pays for services through two mechanisms.  If the infant is in foster care, the facility receives a bundled payment from the state Medicaid program and the Bureau of Children and Families. If the infant is not in foster care, the state Medicaid program pays for physician visits using a fee-for-service schedule. The health care providers said that they also receive funding through grants and private donations to help cover the costs of NAS services.

In criticizing HHS the GAO said, HHS does not include in its strategy: the explicit priorities among the numerous recommendations and associated efforts the Department has initiated related to NAS;  timeframes for partial or full implementation of these recommendations; clear roles and responsibilities for the recommendations, such as the extent to which HHS will need to rely on the medical community and federal and public stakeholders for implementation; and the methods that will be used to assess the department’s progress in implementing any of these recommendations.

According to the GAO, the HHS response was:

“HHS…the department will develop and implement a plan—that will include priorities, timeframes, roles and responsibilities, and methods for assessing progress—to address as appropriate and possible, the NAS-related recommendations in its Strategy. HHS also stated that full implementation would be contingent on funding, though it provided no information on how much funding was needed or how the funding would be used.”