2019-12-17

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Submitted by M5FS on Fri, 01/03/2020 - 12:51
Date
2019-12-16
Subject
Guidance for State Medicaid Agencies on Dually Eligible Beneficiaries Receiving Medicare Opioid Treatment Services Effective January 1, 2020

Guidance for State Medicaid Agencies on Dually Eligible Beneficiaries Receiving Medicare Opioid Treatment Services Effective January 1, 2020

Today, CMS released an Informational Bulletin to states about coverage changes for dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) receiving opioid treatment services.  Starting January 1, 2020, Medicare will pay opioid treatment programs (OTPs) through bundled payments for opioid use disorder treatment services, including medication-assisted treatment medications, toxicology testing, and counseling as authorized under the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act).

For dually eligible beneficiaries who get OTP services through Medicaid now, starting January 1, 2020, Medicare will become the primary payer for OTP services. OTP providers need to enroll as a Medicare provider in order to bill Medicare. It is possible that not all providers will complete the Medicare enrollment process and be able to bill Medicare as primary payer by this date. In an effort to prevent any disruption in OTP treatment for dually eligible beneficiaries, the Informational Bulletin provides background information on provider enrollment and clarifies options available for states regarding coordination of benefits/third party liability under Medicaid.

Read the enrollment fact sheet for more information on enrolling in Medicare.