Form CMS-10786 Survey of Medicaid Opioid Use Disorder Treatment Provide

Survey of Medicaid Opioid Use Disorder Treatment Providers
PRA Disclosure Statement Thank you for participating in our Survey of Medicaid Opioid Use

Disorder (OUD) Treatment Providers. We value your input. NORC at the University of Chicago
and IBM are conducting this survey on behalf of the Centers for Medicare & Medicaid Services
(CMS), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the
Agency for Healthcare Research and Quality (AHRQ). Particiaption is voluntary. Your
responses will be kept confidential and responses are de-identified for analyses. Any published
reports will summarize the results in the aggregate and will not include individual responses. At
the end of the evaluation, the de-identified data will be provided to CMS, SAMHSA, and
AHRQ, as well as participating state Medicaid agencies and State Opioid Treatment Authorities.
Under the Privacy Act of 1974 any personally identifying information obtained will be kept
private to the extent of the law.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0938-XXX (Expires: XXX). The time required
to complete this information collection is estimated to average 15 minutes, including the time to
review instructions, search existing data resources, gather the data needed, and complete and
review the information collection. If you have comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security
Boulevard, Attn: PRA Reports ClearanceOfficer, Mail Stop C4-26-05, Baltimore, Maryland
21244-1850.
Instructions
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survey. You must use the "Continue" button on the screen after you have responded to a question
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survey later will allow you to return to the same location and finish completing the survey.
We will ask you to provide your National Provider Identifier number (NPI); you may want to
look that up now before you start. This will enable us to reduce the number of questions we ask
in this survey by using NPI to link to other data sources to characterize respondents. Again,
individual level data will be de-identified after linking, will not be shared outside the analytic
team, and responses will only be reported once aggregated.
Again, we greatly appreciate your time and participation. Let’s get started!
Provider Background
Q1.
Do you currently provide SUD services to Medicaid beneficiaries?
o Yes
o No
1

Q2.
[ASK IF Q1 = NO] What are the challenges of being a Medicaid provider? Select all that
apply.
o
o
o
o
o
o
Q3.

Reimbursement levels
Provider enrollment process
Stigma associated with serving Medicaid patients
Lack of information available about being a provider/process of participating
Lack of resources available to support SUD treatment
Other (please specify)
[ASK IF Q1 = NO] Which state-level licensing or regulatory requirements, if any, are
barriers to treating individuals with SUD? Select all that apply.

o
o
o
o
o
o
o

Requirement for additional oversight of some prescribing providers (e.g., NPs)
Limitations on which prescribing providers can treat with MAT (e.g., NPs)
Requirements for counseling that accompany medication-assisted treatment
Take-home medication restrictions
Supervised medication consumption
Mandates on counseling frequency
Mandates on urine testing frequency

[PROGRAMMING NOTE: IF Q1=NO THEN TERMINATE AND DISPLAY: Those are all of
the questions we have for you. Thank you for your participation!].
Q4.

What is your occupation?
o
o
o
o
o
o
o
o

Q5.

Physician (MD/DO)
Physician Assistant
Nurse Practitioner
Certified Nurse Midwife
Certified Registered Nurse Anesthetist
Clinical Nurse Specialists
Pharmacist
Other (please specify)
What is your specialty? Select all that apply [PROGRAMMING NOTE: CREATE
DROPDOWN OF SPECIALTIES].

o
o
o
o
o
o
o
o
o
o
o
o

Addiction Medicine
Addiction Psychiatry
Anesthesiology
Dentistry
Emergency Medicine
Family Medicine
Internal Medicine
Nursing
Obstetrics and Gynecology
Ophthalmology
Pain Management
Pain Medicine
2

o
o
o
o
o
o
o
o
o
Q6.

Pediatrics
Pharmacy
Psychiatry (PM&R)
Primary Care
Psychiatry
Psychosomatic Medicine
Substance Use Disorder
Surgery
Women’s Health Care
Have you received specialty training as any of the following? Select all that apply.

o
o
o
o
Q7.

Licensed Addiction Counselor
Certified Addiction Specialist
Addiction Medicine Specialist
Other (please specify)
What is your National Provider Identifier (NPI)?

o Don’t Know
Provider Setting and Services
Q8.
In what type of setting do you work? If you work in more than one setting, select the two
settings in which you spend most of your time.
o
o
o
o
o
o
o
o
o
o

Acute Care Inpatient Hospital (excluding emergency department)
Acute Care Inpatient Hospital Emergency Department
Hospital Outpatient Department
Opioid Treatment Program
Office-Based Practice
Federally Qualified Health Center
Rural Health Center
Other community based health care or mental health care center
Tribal Health Facility
Indian Health Service Facility

Q9. What types of services does your setting provide? Select all that apply
o Screening and assessment
o Withdrawal management
▪ [Tool tip: “Withdrawal management” is the preferred term to describe the
clinical management or oversight of the biological process of
detoxification from any substance, including OUD].
o Residential services for substance use, excluding MAT for OUD
▪ Individual counseling
▪ Group counseling
o Outpatient services for substance use excluding MAT for opioid use disorder
▪ Individual counseling
3

o
o
o
o
o
Q10.

▪ Group counseling
Medication-Assisted treatment: buprenorphine
Medication-Assisted treatment: methadone
Medication-Assisted treatment: naltrexone
Peer support
Treatment coordination
How many clients does your facility or practice serve? Your best guess is acceptable.

o Don’t Know
Provider Prescribing Characteristics
Now we’ll ask about specific medications you may prescribe, administer, or dispense to patients.
Q11. Do you currently have a Drug Addiction Treatment Act of 2000 waiver (i.e., DATA-2000
waiver) to provide buprenorphine for OUD treatment?
o
o
o
o
Q12.

Yes
No
No, but I’m currently working on getting one.
No, I do not need a DATA-2000 waiver to prescribe buprenorphine.
[ASK IF Q11 = NO] Are you eligible to obtain a DATA-2000 waiver?

o Yes
o No
o Don’t know
Q13.
o
o
o
o

[ASK IF Q11 = YES] According to your waiver, what is your patient limit?
30
100
275
Don’t know

Q14. [ASK IF Q11 = YES or No, I do not need a DATA-2000 waiver to prescribe
buprenorphine] In the last month, how many unique patients have you prescribed buprenorphine
to?
o
(enter number of unique patients here)
o I do not currently treat anyone with buprenorphine
Q15. [ASK IF number of unique patients > 0] How long have you been treating patients using
buprenorphine?
o

[enter number of years here]

Q16. [ASK IF number of unique patients > 0] Do you use telehealth for treating patients for
whom you prescribe buprenorphine?

4

o Yes
o No
Q17. [IF Q9 is blank for buprenorphine OR Q14 = “I do not currently treat…”, FILL “prevent
you from”] [IF Q14 > 0, FILL “are challenges in”] Which factors [prevent you from/are
challenges in] treating patients with buprenorphine? Select all that apply.
o
o
o
o
o
o
o
o
o
o
o
o
o

Patients do not want buprenorphine
Lack of eligible patients
Eligible patients cannot afford it
Limited mental health services to complement medication assisted use
Limited training in prescribing buprenorphine
Limited supervision, mentorship, specialist backups, or professional peer consultation
Do not want to treat patients with buprenorphine: prefer non-medication alternatives
Desire to restrict panel size due to limited capacity to manage OUD patients
Compliance with Drug Enforcement Administration instructions
Concern about medication diversion or misuse
Stigma from other providers for treating patients with buprenorphine
Stigma about OUD patients
Other: please specify

Q18. [ASK IF Q9 = Medication-Assisted treatment: methadone] How many unique patients do
you currently treat using methadone for OUD (i.e., not pain)?
o
enter number here
o I do not currently treat anyone using methadone for OUD (i.e., not pain)
Q19. [ASK IF number of unique patients > 0] How long have you been treating patients using
methadone for OUD (i.e., not pain)?
o

[enter number of years here]

Q20. [ASK IF number of unique patients > 0] Do you use telehealth for treating patients using
methadone for OUD (i.e., not pain)?
o Yes
o No
Q21. [ASK number of unique patients > 0] Do you have the capacity to treat more patients
using methadone for OUD (i.e., not pain)?
o Yes
o No
o Don’t Know
Q22. [IF Q9 is blank for methadone OR Q18 = “I do not currently treat…”, FILL “prevent you
from”] [IF Q18 > 0, FILL “are challenges in”] Which factors [prevent you from/are challenges
in] treating patients with methadone for OUD (i.e., not pain)? Select all that apply.
o Do not work in an Opioid Treatment Program (OTP)
o Patients do not want methadone for OUD (i.e., not pain)
o Lack of eligible patients
5

o
o
o
o
o
o
o
o
o
o

Eligible patients cannot afford it
Limited mental health services to complement medication use
Limited training in prescribing methadone
Limited supervision, mentorship, specialist backups, or professional peer consultation
Do not want to treat patients with methadone: prefer non-medication alternatives
Desire to restrict panel size due to limited capacity to manage OUD patients
Concern about medication misuse
Stigma from other providers for treating patients with methadone
Facility and staff costs to maintain methadone treatment programs
Other (please specify)

Q23. [ASK IF Q9 = Medication-Assisted treatment: naltrexone] How many unique patients do
you currently treat using naltrexone?
o
[enter number here]
o I do not currently treat anyone using naltrexone
Q24. [ASK IF number of patients > 0] How long have you been treating patients using
naltrexone?
o

[enter number here]

Q25. [ASK IF number of patients > 0] Do you use telehealth for treating patients using
naltrexone?
o Yes
o No
Q26. [ASK IF number of patients > 0] Do you have the capacity to treat more patients using
naltrexone?
o Yes
o No
o Don’t Know
Q27. [IF Q9 is blank for naltrexone OR Q18 = “I do not currently treat…”, FILL “prevent you
from”] [IF Q18 > 0, FILL “are challenges in”] Which factors [prevent you from/are challenges
in] treating patients with naltrexone? Select all that apply.
o
o
o
o
o
o
o
o
o
o

Patients do not want naltrexone
Lack of eligible patients
Do not want to treat patients with naltrexone: prefer non-medication alternatives
Do not want to treat patients with naltrexone due to a lack of evidence of efficacy in
practice
Eligible patients cannot afford it
Lack of other mental health services to complement medication use
Lack of information or training on treatment
Lack of capacity to manage eligible patients
Complexity of ordering and storing naltrexone
Other: please specify

6

Q28.
o
o
o
o

How confident are you in your ability to treat patients with OUD?
Not at all confident
Somewhat confident
Very confident
Completely confident

Training and Technical Assistance
Now we have a few questions about training and technical assistance.
Q29. In the past three years, has your state Medicaid agency, or have other sources (e.g., other
state agencies, non-profits, managed care organizations), offered training or other technical
assistance to you on any of the following topics? Please select all that apply.
[Tool tip: Technical assistance includes information and resources, tools and templates,
consultation, or site visits.]
Training
State
Other
Medicaid Sources
Agency

Other Technical
Assistance
State
Medicaid
Agency

Other
Sources

Behavioral Health/Substance Use Disorder Treatment
Privacy concerns regarding Electronic Health Records
(EHR)
DATA-2000 Waiver (e.g., how to obtain the waiver, how
to use the waiver effectively)
Buprenorphine prescribing for OUD
Methadone administration for OUD
Substance use treatment or recovery services, excluding
buprenorphine or methadone for OUD
Recruitment and retention of staff trained to treat OUD
Medicaid SUD reimbursement policies (e.g., telehealth
reimbursement)
SUD treatment and recovery services to youth and
young adults
General Operations
Medicaid reimbursement policies (e.g., telehealth
reimbursement)
Administrative processes (e.g., record keeping)
7

Training (other than privacy concerns) in EHR
Health information technology (HIT) and data use
Enabling services and/or addressing social determinants
of health
Operations (funding, emergency preparedness)
Quality improvement methods
Other (please specify)

Q30. [ASK FOR EACH TRAINING TOPIC FROM MEDICAID SELECTED IN Q29] About
how many hours of training from your state Medicaid agency did you complete?
o

[enter number here]

Q31. [ASK FOR EACH TRAINING TOPIC FROM OTHER SOURCES SELECTED IN
Q29] About how many hours of training from other sources did you complete?
o

[enter number here]

Q32. [ASK FOR EACH TECHNICAL ASSISTANCE TOPIC FROM MEDICAID
SELECTED IN Q29] About how many hours of technical assistance from your state Medicaid
agency did you complete?
o

[enter number here]

Q33. [ASK FOR EACH TECHNICAL ASSISTANCE TOPIC FROM OTHER SOURCES
SELECTED IN Q29] About how many hours of technical assistance from other sources did you
complete?
o

[enter number here]

Q34. What resources are available if you need consultation on SUD treatment or recovery
services?
o
o
o
o
o
o

Professional peer support within your facility or practice
Mentor/preceptor within your facility or practice
Professional peer support outside of your facility or practice
Mentor/preceptor outside of your facility or practice
Access to specialists via ECHO or other e-consult approach
Other (please specify)

Q35. In the past three years, which adjustments, if any, has your practice or facility made to
facilitate treatment of patients with SUD?
o Hired additional staff who can prescribe, administer, or dispense medications for OUD
treatment
o Hired additional staff who can prescribe, administer, or dispense medications for SUD
(excluding OUD) treatment

8

o
o
o
o
o
o
o
o
o

Hired additional staff who can provide SUD counseling and behavioral therapies
Hired peer counselors
Hired staff to support care coordination and/or case management
Implemented strategies to improve staff retention (e.g., offered enhanced benefits)
Implemented telehealth
Integration of treatment resources into EHR
Expanded the use of Health Information Technology
Initiated programs to address social risks/ social determinants of health
Other (please specify)

Medicaid and Regulatory Requirements
We have a couple of questions related to Medicaid and to regulatory requirements.
Q36.
o
o
o
o
o
o

What are the challenges of being a Medicaid provider? Select all that apply.
Reimbursement levels
Provider enrollment process
Stigma associated with serving Medicaid patients
Lack of information available about being a provider/process of participating
Lack of resources available to support SUD treatment
Other (please specify)

Q37. Which state-level licensing or regulatory requirements, if any, are barriers to treating
individuals with SUD? Select all that apply.
o
o
o
o
o
o
o

Requirement for additional oversight of some prescribing providers (e.g., NPs)
Limitations on which prescribing providers can treat with MAT (e.g., NPs)
Requirements for counseling that accompany medication treatment
Take-home medication restrictions
Supervised medication consumption
Mandates on counseling frequency
Mandates on urine testing frequency

COVID-19 Pandemic
The final set of questions asks about your experiences during the COVID-19 pandemic.
Q38. Which of the following have you experienced at your practice or facility during the
COVID-19 pandemic? Select all that apply.
o
o
o
o
o
o
o
o
o

Missed work
Became unemployed
Administered COVID-19 testing
Provided more acute/urgent care visits, as opposed to well visits
Provided more care via telehealth
Provided fewer patient visits overall (including all visit types)
Worked longer hours
Changed delivery of behavioral health services
Faced a lack of personnel or resources (e.g., facility beds, including residential treatment
beds) to meet patient demand

9

o
o
o
o

Had limited access to personal protective equipment (PPE)
Was not provided with emergency policies/protocols in sufficient time
Other: please specify
Did not experience any changes at my practice or facility during the COVID-19
pandemic

Q39. [ASK IF Q38=CHANGED DELIVERY OF BEHAVIORAL HEALTH SERVICES]
How has the delivery of behavioral health services changed at your practice or facility during the
COVID-19 pandemic? Select ALL that apply.
o
o
o
o
o
o
o
o
o
o
o
o

Provided more substance use disorder services through telehealth
Delayed scheduling visits with new patients for SUD services
Delayed scheduling routine follow-up visits with patients for SUD services
Delayed toxicology testing for patients who are prescribed buprenorphine
Limited ability to provide mental health visits, excluding SUD treatment
(e.g., took time away from conducting visits, or limited ability to schedule visits)
Limited ability to provide SUD services
Limited ability to provide OUD services, excluding provision of treatment medications
(i.e., buprenorphine, methadone, or naltrexone)
Limited ability to provide OUD treatment medications (i.e., buprenorphine, methadone,
or naltrexone)
Changed buprenorphine prescribing practices (e.g., prescribed larger or smaller supply)
Changed methadone disbursement practices (e.g., provided more take-home doses)
Other: please specify

Q40. [ASK IF Q38=MISSED WORK] Why were you unable to provide services at your
practice or facility during the COVID-19 pandemic? Select all that apply.
o Had to self-isolate or self-quarantine
o Volunteered to be away from my practice or facility to provide care to patients at a
temporary/emergency location
o Required to provide care away from my practice or facility to provide care to patients at a
temporary/emergency location
o Travel restrictions or guidance prevented return to the practice or facility
o My practice or facility closed
o My practice or facility laid off staff or reduced staff hours
o Needed to care for children or other family members
o Other: please specify
That was the last question. Please click on the “Submit” button to submit your responses. Once
submitted, your answers cannot be changed.
Thank you again for participating in our survey!