A recent Health Affairs article, “Improving Access To Substance Use Disorder Care In Nursing Facilities,” outlines the need for comprehensive substance use disorder (SUD) care in nursing facilities. The article also provides an overview of the current relevant regulatory landscape, efforts to improve care as well as the need for broader reforms. The article states “Federal law requires equitable care regardless of diagnosis; denial of admission based on SUD status violates the Americans with Disabilities Act of 1990 and has resulted in legal action, complaints to federal agencies, enforcement actions, and fines. However, these challenges have not resulted in sustained improvements in SUD access or care delivery in nursing facilities.”
Other key points, quoted from the article, include:
- Despite growing demand, most nursing facilities remain underprepared to deliver evidence-based SUD care
- More than 90 percent of SNF residents with an opioid use disorder (OUD) diagnosis do not receive medications for OUD (MOUD), including buprenorphine and methadone, despite clear evidence that these treatments reduce mortality by half, even in the absence of adjunctive behavioral therapies.
- Residents also report inadequate access to supportive programming for SUD and undertreatment of pain, compounding risks for poorer outcomes.
- Stigma toward patients with SUD . . . well-documented pattern of admissions discrimination and denials at nursing facilities . . .When accepted, patients are often placed in lower-quality facilities lacking the capacity to meet their SUD needs.
- Addressing these gaps begins with recognizing SUD as a chronic condition that requires ongoing management within the scope of nursing facility services.
- Limited access to MOUD, especially methadone, remains a common barrier to SUD care in nursing facilities.
- many nursing facilities fall short, failing to develop adequate care plans, train staff appropriately, or provide necessary behavioral health services, highlighting both facility-level shortcomings and insufficient governmental oversight to enforce existing standards.
- A foundational barrier to SUD care in nursing facilities is the lack of standardized staff training and protocols.
- To meaningfully improve access to SUD care in nursing facilities, Medicare should apply full parity protections to mental health and SUD treatment.
- Although Medicare Part B began covering methadone in OTPs in 2020, OTPs do not universally accept Medicare and represent only 10 percent of all SUD treatment programs. Buprenorphine is covered under Part D, but many plans require prior authorization or impose dosage restrictions despite updated Food and Drug Administration guidance removing dose ceilings. Removing all prior authorization barriers for buprenorphine and expanding Part D coverage of evidence-based SUD medications would promote their use in nursing facilities.
September 25, 2025 – K. Kertesz