In the last five years, Medicaid spending on urine tests in Nevada increased from 26,285 tests performed in 2014 at a cost of $4.1 million to 152,041 tests in 2018 at a cost of $58.5 million.

Officials attribute the increase to the Affordable Care Act.

“We had newly eligible people who could now join Medicaid,” Erin Lynch of the Division of Health Care Financing and Policy told the Current. “This included the childless adult population. Just based upon these newly eligible people joining Medicaid, this resulted in a larger population to serve which increased utilization of many of our services.”

But experts say urine testing was on the rise before the advent of the ACA, with Medicare and private insurance billing quadrupling to $8.5 billion between 2011 and 2014, according to a Kaiser Health report. The analysis found 31 pain management providers received at least 80 percent of their total Medicare payments from urine testing.

Congress is examining the connection between drug and alcohol treatment facilities and increased billing for urine tests, and a 2018 report prepared by the Government Accountability Office, which investigated facilities in five states, found providers were “billing patients’ insurance for hundreds of thousands of dollars in unnecessary drug testing over the course of several months.”

“I can say that the number of urine drug screens is currently decreasing as there was a policy update effective August 1, 2018 limiting the number of tests allowed to be conducted,” Kaelyne Day of the Nevada Division of Health Care Financing and Policy said.

“Currently, limitations for presumptive testing allow billing for one per day, per person with a maximum of 20 allowed per 12 rolling months, and limitations for definitive testing allow billing three per recipient in 12 rolling months,” Day told the Current. “If more tests are needed within the 12 rolling months, a prior authorization showing medical necessity would need to be reviewed prior to additional tests being conducted.”