Quinn Amity E, Stewart Maureen T, Brolin Mary, Horgan Constance M, Lane Nancy E
a Senior Research Associate, Institute for Behavioral Health, The Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA.
b Scientist, Institute for Behavioral Health, The Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA.
J Psychoactive Drugs. 2017 Apr-Jun;49(2):151-159. doi: 10.1080/02791072.2017.1301600. Epub 2017 Mar 28.
The Affordable Care Act (ACA) expanded insurance benefits and coverage for substance use disorder (SUD) treatment and encouraged delivery and payment reforms. Massachusetts passed a similar reform in 2006. This study aims to assess Massachusetts SUD treatment organizations' responses to the ACA. Organizational interviews addressing challenges of and responses to the ACA were conducted in person June-December 2014 with 31 leaders at 12 treatment organizations across Massachusetts. Many organizations were affiliated with medical or social services and offered a range of SUD services. Sampling was based on services offered (detoxification only, detoxification and outpatient, outpatient only). Framework analysis was used. Challenges identified were considered similar to ongoing challenges, not unique to the ACA. Organizations experienced insurance expansions in 2006 and faced new challenges, including insurance coverage, payment arrangements, expansion of services, and system design. System design efforts included care coordination/integration, workforce development, and health information technology. Differences in responses related to connections with medical and social service organizations. Many organizations engaged in efforts to respond to changing policies by expanding capacity and services. Offering a range of SUD treatment (e.g., detoxification and outpatient) and affiliating with a medical organization could enable organizations to respond to new insurance, delivery, and payment reforms.
《平价医疗法案》（ACA）扩大了物质使用障碍（SUD）治疗的保险福利和覆盖范围，并鼓励进行服务提供和支付改革。马萨诸塞州在2006年通过了一项类似的改革。本研究旨在评估马萨诸塞州物质使用障碍治疗机构对《平价医疗法案》的反应。2014年6月至12月，对马萨诸塞州12个治疗机构的31名负责人进行了面对面的组织访谈，讨论了应对《平价医疗法案》的挑战及措施。许多机构隶属于医疗或社会服务部门，并提供一系列物质使用障碍服务。抽样基于所提供的服务（仅戒毒、戒毒和门诊、仅门诊）。采用了框架分析方法。所确定的挑战被认为与持续存在的挑战相似，并非《平价医疗法案》所特有。各机构在2006年经历了保险范围的扩大，并面临新的挑战，包括保险覆盖、支付安排、服务扩展和系统设计。系统设计工作包括护理协调/整合、劳动力发展和健康信息技术。应对措施的差异与与医疗和社会服务机构的联系有关。许多机构努力通过扩大能力和服务来应对不断变化的政策。提供一系列物质使用障碍治疗服务（如戒毒和门诊）并与医疗组织建立联系，可以使机构应对新的保险、服务提供和支付改革。
