CMS is implementing policies to expand access to opioid use disorder (OUD) treatment services furnished by opioid treatment programs (OTPs). These new policies will be covered under the Medicare Part B benefit and have been finalized under the 2020 Physician Fee Schedule. Prior to the passage of the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act” in 2018, OTPs could not enroll as providers in Medicare.
Medicare will pay enrolled opioid treatment programs bundled payments based on weekly episodes of care for services including:
- FDA-approved treatment medications for the treatment of OUD, including methadone
- The dispensing and administration of such medications (if applicable)
- Substance use counseling
- Individual and group therapy
- Toxicology testing
Medicare will also make payment adjustments to the bundled payment amount for intake activities and periodic assessments, which are required by SAMHSA, as well as for additional counseling and therapy, and take-home supplies of medications. Furthermore, Medicare beneficiaries will not have a copayment for opioid treatment program services in 2020. OTPs will be required to be fully certified by SAMHSA and enrolled in Medicare to be paid under the new Medicare Part B benefit.
CMS has released a fact sheet for interested providers. Download it by clicking here.