Trump Administration takes Steps to Expand Access to Treatment for Opioid Use Disorder
The CY 2020 Physician Fee Schedule Final Rule (CMS-1715-F) establishes Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs
Today, as a part of the Trump Administration’s continued efforts to combat the opioid epidemic, the Centers for Medicare & Medicaid Services (CMS) is implementing policies to expand access to opioid use disorder (OUD) treatment services furnished by opioid treatment programs (OTPs). Opioid treatment programs treat individuals with OUD using medication and other services. This new Medicare Part B benefit was mandated under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that President Trump signed into law on Oct. 24, 2018.
Historically, OTPs could not enroll as providers in Medicare or be paid for services provided to Medicare beneficiaries, but under the policies adopted in today’s final rule, beginning January 1, 2020, Medicare will pay for OUD treatment services provided by OTPs, including methadone. Today’s final rule will increase access to OUD treatment options for Medicare beneficiaries. In addition, Medicare will cover in person and virtual delivery of counseling and therapy services furnished by OTPs, broadening access to these critical services, particularly for those living in rural areas who are often the hardest hit by the opioid crisis.
“2018 saw the first decline in the rate at which Americans have overdosed on prescription opioids in almost 30 years, yet only 20 percent of people with OUD receive the treatments or counseling they need,” said CMS Principal Deputy Administrator for Operations and Policy Kimberly Brandt. “Today’s final rule represents a significant opportunity to increase that percentage by offering more treatment options for the people who desperately need them.”
Medicare will pay enrolled OTPs bundled payments based on weekly episodes of care for services including:
- FDA-approved treatment medications for the treatment of OUD,
- The dispensing and administration of such medications (if applicable),
- Substance use counseling,
- Individual and group therapy, and
- 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 OTP services in 2020.
OTPs will be required to be fully certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and enrolled in Medicare to be paid under the new Medicare Part B benefit.
To further increase access to OUD treatment, CMS is also establishing a new bundled payment under the Medicare Physician Fee Schedule for OUD treatment services furnished by clinicians in an office or outpatient setting. OUD treatment services in this bundle include: overall care management, care coordination, individual and group psychotherapy, and counseling. This bundled payment approach reduces clinician burden by allowing practitioners to bill once for these services rather than separately for each service. This effort will also improve payment for critical services to support Medicare beneficiaries who have an OUD.
CMS continues to engage in a range of efforts to address the opioid crisis using a three-pronged strategy that includes prevention, treatment and data. The changes in the Physician Fee Schedule final rule (CMS-1715-F) represent significant progress in expanding access to treatment. CMS encourages OTPs to begin the enrollment process with Medicare so that Medicare beneficiaries, including those dually eligible for Medicare and Medicaid, can receive access under Medicare to these critical services. Enrollment information is available at the OTP webpage (https://www.cms.gov/Center/Provider-Type/Opioid-Treatment-Program-Center.html).
Medicare beneficiaries with OUD, their families and their caregivers, are encouraged to talk with OTP professionals about this new benefit and ensure that they have access to the treatment they need.
For more information, please refer to the CY 2020 Physician Fee Schedule final rule fact sheet: https://www.cms.gov/newsroom/fact-sheets/finalized-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar
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