Developing Medicare and Medicaid Substance Abuse Treatment Spending Estimates. I. Proposed Methodology for Producing Medicare Substance Abuse Treatment Expenditures Estimates


In this section, we propose a methodology for developing estimates of Medicare SA treatment spending. The methods parallel the approach used to develop Medicaid spending estimates in this project. In Section A, we provide an overview of Medicare coverage of SA treatment services and the payment approaches Medicare uses to reimburse providers for these services. In Section B, we discuss Part A and B expenditures. In Section C, we propose methods for imputing SA treatment expenditures for Medicare Advantage (MA) managed care beneficiaries, based on fee-for-service (FFS) spending on SA treatment services and encounter data (when those data become available for 2012 and later years). Finally, in Section D, we discuss Part D, prescribed drug expenditures.

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