Reducing Substance Use Disorders - Technical Support for Medicaid Agencies

Opioid Data Analytics Cohort

Expression of Interest Form

ThisExpression of Interest (EOI) form is intended to guide the Medicaid Innovation Accelerator Program’s (IAP) selection of states for participation in the Opioid Data Analytics Cohort. A Program Overview document which describes the technical support available for state Medicaid agencies can be found on theReducing Substance Use Disorders page on Medicaid.gov.

Selection process and next steps:IAP will notifythe statesselectedfor participation inthis collaborative learning opportunitybyApril2018.Up to 12 states will be selected. If there is overwhelming interest, IAP will consider, based on availability of resources, creatinga second round of the Opioid Data Analytics Cohort to run later in the year. Priority for selection in the initial round will be based on states’ interest, ability to actively engage in all three analytical components of the cohort,and on the inclusion of single state agency staff as team members.

Instructions: Complete the Expression of Interest Form and email it to by February 28, 2018 midnight ET. For questions about this technical support opportunity, contact .

For more information about IAP SUD technical support opportunities available to states, visit the Reducing Substance Use Disorders page on Medicaid.gov.

Opioid Data Analytics Cohort

Expression of Interest Form

  1. Name of your State Medicaid Agency: Click here to enter text.
  2. Name of your State Medicaid Director: Click here to enter text.
  3. The state Medicaid Director acknowledges that the state is seeking this IAP technical support:

☐Yes ☐No

  1. The state Medicaid Director acknowledges that the team has or will have sufficient staff time and resources committed to this effort:

☐Yes ☐No

Area(s) of Focus:Please indicate which component(s) of the Data Analytics Cohort your state plans to join.

Opioid Use Disorder Analytics:

☐Yes ☐No

Medication-Assisted Treatment Analytics:

☐Yes ☐No

Neo-Natal Abstinence Syndrome and Opioid Maternity Care Analytics:

☐Yes ☐No

Additional, state-specific opioid data analytics request:Click here to enter text.

Team Lead:Please provide contact information for the state Medicaid agency team lead for this work

Name / Title & Medicaid Agency / Email Address / Phone Number
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /

Team Members: Names of state Medicaid behavioral health program staff members and state data experts/staff members who will participate (both are strongly encouraged), as well as any additional Medicaid officials who will participate.

Name / Title & Organization / Email Address / Phone Number
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /

Single State Agency Staff (Recommended):Names of the single state agency for substance abuse staff members who will participate. (Note: For the NAS component, we also recommend collaboration with state health department staff. Please include information for state health department staff who will participate.)

Name / Title & Organization / Email Address / Phone Number
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
  1. Provide a brief description of your state’s planned goals and activities involving opioid data analytics. Explain how these goals align with what your state intends to achieve through its participation in IAP. Identify the roles of the key partner agencies that will be involved.

1/29/18

1