infant’s insurance payer, such as the state Medicaid program, it does not require information on total Medicaid payment. ICD codes are the standard code set used in the U.S. to document patient medical diagnoses. ICD10 (tenth revision) codes have been in effect since October 1, 2015. 31Infants with NAS in this study were identified using the ICD-9 code 779.5 (drug withdrawal syndrome in a newborn). This estimate was determined through analysis of aggregate hospital charges by payer. The study noted that hospital charges do not equal hospital costs and do not include professional fees. Patrick et al., “Increasing Incidence and Geographic Distribution of Neonatal Abstinence Syndrome,” 651. Page 16 GAO-18-32 Newborn Health While most infants with NAS typically complete treatment in a hospital setting, stakeholders told us that some of these infants may be transferred to a non-hospital setting to complete pharmacologic treatment and continue non-pharmacologic treatment. HHS officials told us that there is not a comprehensive list of facilities that may treat infants with NAS outside of the hospital. Based on information from the stakeholders we interviewed and the literature we reviewed, we identified two types of non-hospital settings available in certain states that treat infants with NAS: (1) outpatient clinics and programs and (2) neonatal withdrawal centers. For the purposes of this report, we defined neonatal withdrawal centers as facilities that can treat infants who are prenatally exposed to drugs, including infants with NAS, within the facility. Outpatient clinics and programs to treat NAS Through stakeholder interviews and the literature we reviewed, we identified examples of outpatient clinics and programs in certain states where infants with NAS can continue pharmacologic treatment after their discharge from the hospital. For example, some stakeholders we interviewed told us about a Neonatal Medical Follow-Up Clinic in Vermont used to follow-up with infants with NAS who have been discharged from the hospital and are being weaned off methadone on an outpatient basis. Hospital providers train the infant’s family on how to administer the infant’s medication at home and provide a referral to the clinic. After hospital discharge, the infant and family have follow-up visits in the clinic every 1 to 2 weeks, during which the family discusses with health care Some Infants with NAS May Complete Treatment in NonHospital Settings Available in Certain States, and in These States Medicaid Pays for a Subset of Services Non-Hospital Settings for Treating Infants with NAS Page 17 GAO-18-32 Newborn Health providers the weaning schedule and demonstrate how they administer the infant’s medication.32 Health care providers told us that they also encourage the family to continue providing non-pharmacologic treatment to the infant. After weaning is complete, the infant continues to follow-up at the clinic every 1 to 2 months until the infant reaches 12 to 18 months of age. Literature we reviewed indicated that other outpatient treatment clinics or programs such as the one in Vermont have been established or considered in other states. Specifically, four studies we reviewed described instances in which infants began their treatment in the hospital but completed their treatment through a dedicated outpatient program in Florida, Ohio, and Pennsylvania.33 Each study noted that the inpatient-tooutpatient approach can result in a shorter hospital length of stay. For example, one 2015 study found that infants who began treatment in a hospital and completed their treatment in an outpatient setting stayed in the hospital an average of 11 days, compared to infants who completed treatment in the hospital, where the stays averaged about 25 days.34 However, the studies also noted that the inpatient-to-outpatient approach resulted in a longer overall treatment duration across the two settings. Neonatal withdrawal centers to treat NAS Some stakeholders we interviewed, including health care providers, described examples of neonatal withdrawal centers in two states, where infants with NAS can continue pharmacologic treatment after their 32According to health care providers, to ensure that a mother is administering the medication correctly to her infant, the mother must bring the medication to the follow-up visits so that these providers can measure the amount of medication left over. 33See CH Backes et al., “Neonatal Abstinence Syndrome: Transitioning MethadoneTreated Infants from an Inpatient to an Outpatient Setting,” Journal of Perinatology, vol. 32, no.6 (2012); Kim T. Chau et al., “Outpatient Management of Neonatal Abstinence Syndrome: A Quality Improvement Project,” The Joint Commission Journal on Quality and Patient Safety, vol. 42, no. 11 (2016); Katherine E. Gregory, “Caring for the Infant with Neonatal Abstinence Syndrome in a Community-Based Setting,” The Journal of Perinatal & Neonatal Nursing (2014); and Jerry Lee et al., “Neonatal Abstinence Syndrome: Influence of a Combined Inpatient/Outpatient Methadone Treatment Regimen on the Average Length of Stay of a Medicaid NICU Population,” Population Health Management, vol. 18, no.5 (2015). 34The study examined data between 2007 and 2013 from one managed care plan in Pennsylvania. See