Opioid Treatment Programs
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.
- 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.