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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, see Sustainability Strategies 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. For example:

  • 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

Medicaid 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 overdose.

Medicare 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 services.

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 or SUD-related telehealth services.

Resources to Learn More

Budgeting and Program Sustainability
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
Journal Article
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
Date: 12/2016