told us that the state Medicaid program pays about $56 per day per infant while the Bureau of Children and Families pays about $313 per day per infant. The payment helps to cover some of the facility’s cost for medical care and room and board. 41Medicaid managed care plans have the flexibility to cover services not included in the state Medicaid plan, but if they do so, the plans may bear the financial risk of providing any additional services. Page 23 GAO-18-32 Newborn Health specially trained caregivers to provide infants with non-pharmacologic treatment and hands-on care, such as feeding and bathing. These providers also said they use volunteers to help with household duties, such as laundry and replenishing supplies. • A health care provider from the neonatal withdrawal center in West Virginia conducted a study that found that the average daily charges per infant were about $400 in their facility, compared to about $2,600 in a special care nursery and $4,000 in a NICU.42 • Two studies we reviewed found that inpatient-to-outpatient treatment approaches reduced hospital costs for NAS treatment; however, these studies were not generalizable and did not account for the duration of treatment across the two settings. Specifically, one study found that an inpatient-to-outpatient treatment approach reduced hospital length of stay by 55 percent—estimated to save hospitals $396 million annually—compared with treatment provided solely in a hospital.43 The second study found that infants who received care for NAS through an inpatient-to-outpatient treatment approach had an average length of stay of 13 days and cost about $14,000, while an inpatientonly approach had an average length of stay of 25 days and cost about $28,000.44 42S. Loudin et al., “A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic,” Journal of Perinatology (July 6, 2017). Facility staff told us that the average daily cost per infant was about $600. 43The study examined data between 2007 and 2013 from one managed care plan in Pennsylvania. See Lee et al., “Combined Inpatient/Outpatient Methadone Treatment.” 44The study examined data between January 2007 and January 2009 from a nongeneralizable sample of infants at the Ohio State University Medical Center. See CH Backes et al., “Neonatal Abstinence Syndrome: Transitioning Methadone-Treated Infants from an Inpatient to an Outpatient Setting.” Page 24 GAO-18-32 Newborn Health The 32 stakeholders we interviewed and the literature we reviewed identified several recommended practices for addressing NAS—that is, treating women with opioid use disorders during pregnancy or treating infants diagnosed with NAS after birth. The most frequently recommended practices were (1) prioritizing non-pharmacologic treatment, such as allowing the mother to reside with the infant during treatment, to facilitate the mother-infant bond; (2) educating mothers on prenatal care, treatment for NAS, and available resources for after an infant’s discharge; (3) educating health care providers on the stigma faced by women who use opioids during pregnancy and on how to screen for and treat NAS; and (4) using a protocol in a hospital or non-hospital setting for screening and treating infants with NAS.45 These recommended practices are described in more detail below. Prioritizing non-pharmacologic treatment for NAS to facilitate the mother-infant bond. Most stakeholders we interviewed and several of the literature articles we reviewed noted that non-pharmacologic treatment for NAS, such as allowing a mother to stay in the room with the infant in the hospital or other treatment location, should be prioritized prior to initiating pharmacologic treatment. The stakeholders and literature 45We counted the number of times stakeholders we interviewed cited a practice to determine the most commonly identified recommended practices. We included a recommended practice if at least ten of the 32 stakeholders we interviewed identified it. Many of these practices are similar to those we have identified in prior work on NAS. See GAO-15-203. Recommended Practices for Addressing NAS Include Prioritizing Non-Pharmacologic Treatment, While Challenges Include Maternal Use of Multiple Substances Recommended Practices for Addressing NAS Include Prioritizing NonPharmacologic Treatment, Educating Mothers, and Addressing Stigma Page 25 GAO-18-32 Newborn Health indicated that non-pharmacologic treatment may (1) facilitate the motherinfant bond, (2) reduce the severity of NAS symptoms, (3) reduce the need for pharmacologic treatment, and (4) reduce the length of an infant’s hospital stay. For example, two of the articles we reviewed noted that rooming-in has been shown to help decrease the need for pharmacologic treatment, the number of admissions to the NICU, and the length of an infant’s hospital stay.46 Additionally, 17 of the stakeholders we interviewed and nine articles we reviewed recommended that mothers be allowed to breastfeed while their infants are treated for NAS, as it helps to build a bond between the mother and infant. Most of these articles also noted that breastfeeding has been shown to reduce the severity of NAS.47 Educating mothers on prenatal care, treatment for NAS, and resources for after