Coverage Limitations for Use of Urine Drug Testing in a State Medicaid Program.

Area of Science:

• Health Services Research
• Health Economics
• Substance Use Disorder Treatment

Background:

• Urine drug testing (UDT) is widely used in substance use disorder (SUD) treatment.
• Evidence guiding optimal UDT use is limited, raising concerns about low-value care.
• The impact of reimbursement policies on UDT utilization and outcomes is not well understood.

Purpose of the Study:

• To evaluate the association between a statewide policy limiting Medicaid reimbursement for UDT and subsequent changes in testing frequency, expenditures, and clinical outcomes.
• To assess the impact of the policy on utilization of presumptive and definitive UDT.
• To compare trends in UDT utilization with a control procedure (colonoscopy) and examine concomitant trends in overdose encounters and medication for opioid use disorder (MOUD) prescriptions.

Main Methods:

• A serial cross-sectional study design was employed using Louisiana Medicaid beneficiary data from July 2017 to February 2020.
• Analysis involved comparing observed trends post-policy enactment (July 2019) with pre-enactment trends, using best-fit lines and controlling for time and intervention period interactions.
• Colonoscopy rates served as a matched control procedure; overdose encounters and MOUD prescriptions were also assessed.

Main Results:

• Following the policy change, monthly rates of total UDT utilization significantly decreased (difference, -1.70 tests per month per 1000 beneficiaries; P < .05).
• Significant reductions were also observed for presumptive UDT (difference, -1.05; P < .05) and definitive UDT (difference, -0.65; P < .05) compared to colonoscopy trends.
• UDT expenditures decreased significantly, resulting in an estimated $14.8 million in savings over the 7-month post-enactment period; no significant changes in MOUD receipt or overdose encounters were noted.

Conclusions:

• A state policy limiting Medicaid reimbursement for UDT was associated with substantial reductions in testing utilization and associated healthcare expenditures.
• The policy effectively reduced potentially low-value care without adversely affecting key clinical outcomes like MOUD receipt or overdose encounters.
• Findings suggest that carefully designed reimbursement policies can optimize the value of UDT in SUD treatment, warranting further investigation into best practices.