Study calls for federal action to address NAS

HUNTINGTON - Every 25 minutes, a baby is born withdrawing from in-utero drug exposure.

"What's heartbreaking is it's getting worse," said Sen. Shelley Moore Capito, R-W.Va., on Wednesday.

The statistic is part of the U.S. Government Accountability Office's study on neonatal abstinence syndrome, or NAS, the first federal study of its kind to examine best practices and approaches to treating newborns exposed to opioids during pregnancy.

Released Wednesday, the report recommends several practices to address NAS and improve treatment for these newborns, including educating expectant mothers on prenatal care, educating health care providers on screening and treating NAS, as well as addressing the stigma faced by pregnant women who use opioids that keeps them from getting treatment.

The report also calls on the Department of Health and Human Services to expeditiously develop a plan for implementing the recommendations.

Rep. Evan Jenkins, R-W.Va., introduced legislation, the NAS Healthy Babies Act, to require the study, which the House passed last year. After work done by Jenkins and Captio, the legislation was included in the final version of the Comprehensive Addiction and Recovery Act, which was signed into law by the president.

"There's an old saying: You can only manage what you measure," Jenkins said. "... Incredible research has been done in treatment of NAS, good work being done by Dr. Sean Loudin, the Marshall med school and at Cabell Huntington Hospital and Lily's Place that is moving the needle. This report is a broader, multifaceted analysis that also identifies the next steps with HHS and other governmental bodies needed to step up to the plate to take action to help every child."

The GAO focused on four states for the study - West Virginia, Vermont, Kentucky and Washington. Officials visited Lily's Place and the Hoops Family Children's Hospital at Cabell Huntington Hospital during the course of their research.

The study found that despite more than 80 percent of NAS cases being paid for by Medicaid, it was still nearly impossible to determine the number of NAS cases in the four focus states.

Part of the issue is coding for treatment is only listed under two non-specific categories. Two of the four states had public health surveillance systems that track NAS cases, but those rely on self-reporting.

There is also no single national standard of care for screening and treating NAS. While most stakeholders that researchers talked to said they use a standard protocol, officials in West Virginia told researchers that facilities in the state without children's hospitals may not even have a standard practice of keeping babies long enough to identify symptoms of NAS.

"One of the reasons Evan and I wanted to move forward to get the full scope had a lot to do with data," Capito said. "It's important HHS comes forward with standards for reporting, how to recognize NAS and what data and research can be pulled together so they can further recommend treatment, but also prevent these things from happening."

The study also looked at the costs associated with treating NAS, which was also hard to determine. Still, six of the eight hospitals reported that in calendar year 2016, the average Medicaid payment for treating NAS was between $1,500 and $20,200, depending on the type and duration of treatment. A study from 2012 said Medicaid payments to hospitals for NAS increased from $564 million in 2009 to $1.2 billion nationwide.

A study done by Loudin found it costs about $400 a day to care for an infant, compared to about $2,600 in a special care nursery and $4,000 in the neonatal intensive care unit in the hospital.

"We know not one single solution is the answer," Capito said. "I think that finding the best way to use the dollars we appropriated through CARA and the data generated will tell us not just where the problem lies but how to make dollars more effective."

Jenkins said this is just the beginning.

"We have other pending legislation, and this report is a critical and helpful roadmap for our future efforts," he said. "And it will help governmental entities be held accountable to make sure they address this most urgent issue."

Jenkins and Capito have introduced the Caring Recovery for Infants and Babies (CRIB) Act in both the House and Senate. It would build on the best practices of Lily's Place for treating NAS babies and make it easier for similar centers to open across the country by cutting regulatory red tape.