Methodology
This page documents the data pipeline behind CCIWA. Read it if you care how a number on this site got there. We list every source, every vintage, every transformation, and every rule that decides whether a clinic gets published.
Source datasets
| Dataset | Source | Vintage | Use |
|---|---|---|---|
| CMS Medicare Provider OTP file | CMS | 2026-01-05 | Methadone clinic certification list |
| NPPES NHRS | HHS / CMS | 2026-04-13 | Provider identity, address, phone |
| SAMHSA FindTreatment | SAMHSA | 2026-04-25 | Service cross check |
| KFF Medicaid BH Services Survey | KFF | Most recent published | State Medicaid coverage |
| KFF 1115 Waiver Tracker | KFF | Most recent published | 1115 SUD waiver status |
| CDC WONDER MCD | CDC NCHS | 2023 final, 2024 provisional | Overdose mortality |
| CDC Prescribing Rate | CDC | 2024 | Opioid prescribing intensity |
| HRSA HPSA Quarterly | HRSA | Q1 2026 | Workforce shortage context |
| U.S. Census ACS 1-year | U.S. Census Bureau | 2023 | Demographics, uninsured rate |
| PDAPS State Law Tracker | Temple LawAtlas | Most recent published | State law context |
| MACPAC SUD Utilization | MACPAC | FY 2022 | Medicaid SUD utilization |
| HRSA HPSA Mental Health (full file) | HRSA Data Warehouse | Pulled latest at build | TAPI HPSA-weighted score, county HPSA designations |
| CDC PLACES MHLTH | CDC, BRFSS 2022 | 2024 release | TAPI county and state frequent mental distress prevalence |
| BLS Local Area Unemployment Statistics | U.S. Bureau of Labor Statistics | Latest monthly release | TAPI state unemployment stress proxy |
Clinic publishing rules
- Methadone listings require an active record on the CMS OTP file.
- Each clinic must have a current NPI, deliverable address, and phone number.
- Where CMS and NPPES disagree on phone or address, we publish the CMS value and flag the disagreement.
- Buprenorphine listings come from NPPES specialty filters; we do not republish the closed SAMHSA practitioner list since it has been deprecated post CAA 2023.
- City pages publish only when at least one verified clinic exists in that city. Suboxone city pages additionally require at least 5 active prescribers to avoid thin pages.
State Access Score
The State Access Score is a transparent composite. It is not a peer reviewed instrument and we present it as a relative comparison aid, not a treatment quality judgment.
Inputs. Treatment supply per capita (OTPs and active buprenorphine prescribers per 100,000 residents), Medicaid MOUD coverage flags, 1115 SUD waiver status, opioid age-adjusted overdose mortality rate, and HRSA mental health HPSA workforce coverage.
Construction. Each input is normalized to a 0 to 100 scale. Supply inputs are scored relative to the national distribution. Coverage flags contribute fixed points if the service is covered. Mortality rate is inverted so higher mortality reduces the score. The composite is a weighted sum, not a proprietary black box. The exact weights are listed below.
| Component | Weight |
|---|---|
| OTP supply per 100K | 20% |
| Buprenorphine prescriber supply per 100K | 20% |
| Medicaid MOUD coverage breadth | 20% |
| 1115 SUD waiver and IMD treatment | 10% |
| Opioid overdose mortality (inverted) | 20% |
| HRSA mental health HPSA coverage | 10% |
Letter grade mapping. 80 to 100 = A. 70 to 79 = B. 60 to 69 = C. 50 to 59 = D. Below 50 = F.
Treatment Access Pressure Index (TAPI)
TAPI is a CCIWA composite that scores how strained behavioral health treatment access is in each state. It exists alongside the State Access Score and answers a different question. Where the Access Score asks "how good is the supply side here," TAPI asks "how much pressure is on the supply side from demand and workforce shortage signals." A state can score well on one and poorly on the other.
Inputs. Four primary federal sources are joined on FIPS:
- HRSA HPSA Mental Health, weighted by designated population. Higher score = larger federally designated workforce shortage.
- CDC PLACES MHLTH, the model-based small-area estimate of frequent mental distress (14+ poor mental health days in the last month). Population-weighted to state level.
- BLS Local Area Unemployment Statistics, latest seasonally adjusted state unemployment rate. Used as a generic stress proxy.
- Verified treatment density per 100,000 residents. Methadone OTPs plus buprenorphine prescribers from the CCIWA dataset. Sign-flipped so higher density lowers TAPI.
Construction. Each input is z-scored across 50 states plus DC and Puerto Rico. The weighted sum is HPSA 30%, frequent mental distress 25%, unemployment 15%, treatment density 30% (sign-flipped). The result is rescaled to a 0 to 100 percentile rank.
| Component | Weight | Direction |
|---|---|---|
| HPSA mental health weighted score | 30% | Higher = more pressure |
| Frequent mental distress prevalence | 25% | Higher = more pressure |
| State unemployment rate | 15% | Higher = more pressure |
| Verified treatment density per 100K | 30% | Lower density = more pressure |
Caveats. TAPI is a relative score. A lower-pressure state can still have meaningfully underserved counties. Treatment supply uses methadone OTPs and buprenorphine prescribers, not the full behavioral health workforce. PLACES MHLTH is a model-based estimate, not a direct survey, and PLACES does not publish Puerto Rico, so PR uses median imputation on that one input. HPSA scores reflect federal designation criteria, not real-time wait times.
County data. The TAPI build also produces a county-level dataset that joins HPSA designations with PLACES MHLTH on 5-digit FIPS. City pages reference county-level prevalence where it exists.
Limitations we acknowledge
- NPPES does not flag a provider as actively accepting MOUD patients. A listing means a clinician with a relevant specialty exists at that address, not that they have intake capacity today.
- 2024 final overdose mortality state data is not yet released by CDC NCHS at the time of build. We use 2023 final data and 2024 provisional where available.
- NY is excluded from MACPAC FY 2022 utilization data per the MACPAC source note.
- FL 1115 SUD waiver shows as pending. We label it pending, not active.
- The composite score is directional. Two states within 5 points are not meaningfully different.
Refresh policy
The build script regenerates all manifests on each release. State Access Scores recompute when any input dataset refreshes. The site footer carries the build date. Material methodology changes are logged on the methodology changelog.