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Opioid Treatment Programs

Background

MBI Graphic

Section 2005 of the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act established a new Medicare Part B benefit for opioid use disorder (OUD) treatment services, including medications for medication-assisted treatment (MAT), furnished by opioid treatment programs (OTPs). To meet this statutory requirement, CMS is specifically proposing:                                               

  • Definitions of OTP and OUD treatment services;
  • Enrollment policies for OTPs;
  • Methodology and estimated bundled payment rates for OTPs that vary by the medication used to treat OUD and service intensity, and by full and partial weeks;
  • Adjustments to the bundled payments rates for geography and annual updates;
  • Flexibility to deliver the counseling and therapy services described in the bundled payments via two-way interactive audio-video communication technology as clinically appropriate; and
  • Zero beneficiary copayment for a time limited duration.

CMS intends to implement this benefit beginning January 1, 2020, as required by the SUPPORT Act. View the proposed rule (CMS-1715-P) and submit public comment on our proposals via the official comment submission process no later than 5pm on September 27, 2019.

Important Links

Enrollment/Certification

  • OTPs require certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accreditation by a SAMHSA-approved accrediting body. For more information, please visit SAMHSA’s Certification of Opioid Treatment Programs (OTPs) webpage.

Additional CMS Information

How to Stay Informed