CREDENTIALING, LICENSING, AND REIMBURSEMENT OF THE SUD WORKFORCE: A REVIEW OF POLICIES AND PRACTICES ACROSS THE NATION

CREDENTIALING, LICENSING, AND REIMBURSEMENT OF THE SUD WORKFORCE:
A REVIEW OF POLICIES AND PRACTICES ACROSS THE NATION

Nilufer Isvan, Rachael Gerber, David Hughes, Kristin Battis, and Evan Anderson
Human Services Research Institute

John O'Brien
Technical Assistance Collaborative

November 2019

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ABSTRACT

The main purpose of this study was to investigate the barriers to and facilitators of licensing, credentialing, and insurance reimbursement for substance use disorder (SUD) treatment providers across the nation. The study included an environmental scan of key issues, reviews of credentialing, licensing, and reimbursement policies in the 50 states and D.C., and in-depth case studies of four states that implemented innovative strategies to incentivize their SUD workforce.

The study identified as key barriers to entry to the field: (1) variability across (and in some cases, within) states in career ladders and certification/licensing requirements; (2) low education requirements for qualification, lack of education programs focusing on SUD treatment; (3) unavailability of licensure in 20 states; (4) Lack of pathways to independent practice; (5) lack of insurance coverage for SUD services; and (6) low reimbursement rates compared to other behavioral health professions. The results of this study suggest that state-level system redesign efforts are most effective when accompanied by initiatives to support providers in adapting their practices to the new environment. Establishing state licensure statutes is a strong facilitator of insurance reimbursement, especially if accompanied by workforce development efforts and grandfathering clauses for existing practitioner.

This report was prepared under contract #HHSP233201600015 between HHS's ASPE/DALTCP and the Human Services Research Institute. For additional information about this subject, you can visit the DALTCP home page at https://aspe.hhs.gov/office-disability-aging-and-long-term-care-policy-daltcp or contact the ASPE Project Officers, Judith Dey and Kristina West, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201; Judith.Dey@hhs.gov, Kristina.West@hhs.gov.

DISCLAIMER: The opinions and views expressed in this report are those of the authors. They do not reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. This report was completed and submitted on February 2019.