Sustainability Strategies for Rural SUD Programs
There are several different strategies for promoting the sustainability of rural substance use
disorder (SUD) programs. For general information on program sustainability,
Strategies and Sustainability
Strategies for Specific Issues in the Rural Community Health Toolkit.
Building Staff Capacity
Some rural SUD programs focus on building staff capacity to continue program
activities after initial grant funding ends. This entails ensuring staff have the knowledge and
skills necessary to do their jobs. Some rural communities have developed trainings or curriculums,
such as train-the-trainer models, to support their ability to train staff in the future.
Maintaining and Expanding Partnerships
Rural programs often emphasize the importance of working with partner organizations to plan for
sustainability. In some cases, partners may take on responsibility for continuing certain program
components, such as program activities, services, staff training, or other implementation activities.
Hospitals make training on SUD an annual requirement for staff
Community-based organizations integrate educational efforts into existing harm reduction efforts
Law enforcement agencies monitor prescription drug drop boxes that are in fixed locations in the community
Some rural SUD programs develop plans to maintain existing partnerships, while also seeking to develop new
partnerships to support sustainability. It may be necessary to partner with new organizations to maximize
sources of support — including funding, time, and staff — for sustaining key activities.
Developing Materials to Support Replication
Some programs support sustainability through replication and expansion. To provide support for program
replication in other communities, some rural SUD programs prepare materials with guidelines and lessons learned
for designing, implementing, evaluating and sustaining the intervention. For more information on strategies for
disseminating program information, see Module 7.
Exploring Sustainable Funding Models
coverage for SUD treatment and recovery services varies from state to state. Not all Medicaid programs
will cover all SUD-related services, such as recovery supports, residential treatment, or certain types of
medication-assisted treatment (MAT), including methadone. Program planners may also need to confirm whether all
staff are eligible to bill for services under Medicaid. For example, some states may allow programs to seek
reimbursement for services provided by community
health workers, but may also impose certain training or credentialing requirements. The National Academy
for State Health Policy conducted a 50-state
scan to assess how Medicaid programs are leveraging the non-licensed workforce, including peer
counselors, to address SUD. The scan includes Medicaid reimbursement categories that states are using. In
addition, the Substance Abuse and Mental Health Services Administration offers a report that discusses Medicaid
coverage of MAT for alcohol and opioid use disorders and of medication for the reversal of opioid
coverage for SUD includes a range of inpatient and outpatient treatment options. Rural communities using
telehealth to offer SUD treatment or recovery services should be aware of Medicare polices for coverage of telehealth
Private insurers also commonly cover SUD treatment options. The federal government requires health insurance
plans that participate on the Marketplace to cover essential mental and
behavioral health services, including counseling, inpatient services, and SUD treatment.
Both public and private payers, but especially Medicare
and Medicaid, are
moving toward value-based payments that incentivize providers to increase the quality of care,
decrease healthcare costs, and improve health outcomes. Providers may be rewarded for attaining
certain targets related to SUD treatment and recovery, such as increased screenings for SUD and
referrals to treatment. The Alliance for Recovery-Centered Addiction Health Services is piloting the
Addiction Recovery Medical Home model, in which
providers will share savings associated with higher-quality care for patients in SUD treatment and
recovery. A Center for Health Care Strategies and Technical Assistance Collaborative report describes
value-based payment models that
encourage SUD treatment in primary care.
Working with Policymakers and Payers
Rural communities may need to work with policymakers and payers to ensure sustained access to and
coverage of SUD treatment options. For example, rural communities may need to advocate for increased
coverage for take-home naloxone
Resources to Learn More
Provides resources on program policy and practice with a focus on sustainability planning and
budgeting. Includes examples from states demonstrating a plan supporting sustainability and
identifies information about federal, state, and private funding opportunities.
Organization(s): National Center on Substance Abuse and Child Welfare
Survey Highlights Differences In
Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications
Discusses the significant state-level variations in Medicaid coverage for SUD treatment and in
administering opioid use disorder medications as determined from analyzing data collected during a
2013–2014 survey of state Medicaid programs across the U.S.
Author(s): Grogan, C. M., Andrews, C., Abraham, A., et al.
Citation: Health Affairs, 35(12), 2289–2296