OTP Provisions in 2020 Physician Fee Schedule
CMS finalized provisions for the nation’s opioid treatment programs (OTPs) in the 2020 Physician Fee Schedule regulation that the agency released on Nov. 1.
This NABH Analysis provides a summary of those provisions, which provide for the treatment of opioid use disorders (OUDs) with new bundled service codes for OTPs, and for telehealth and opioid use treatment services in office-based settings. The final rule will be published in the Federal Register on Nov. 15.
The regulations implement requirements that were included in last year’s Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patient and Communities (SUPPORT) Act. NABH is pleased that the final rule addressed the following issues that NABH mentioned in its comment letter on Sept. 28:
Opioid Treatment Programs
PFS Bundles for Office-based Services/Telehealth
NABH will closely monitor and work with CMS and other stakeholders in the implementation of this benefit and provide updates to NABH members as necessary.
If you have questions, please contact Sarah Wattenberg, NABH’s director of quality and addiction services.
NABH Issue Brief: CMS Releases Guidance on IMDs Providing Treatment to Medicaid Beneficiaries with At Least One SUD
|CMS Releases Guidance on IMDs Providing Treatment to Medicaid Beneficiaries with At Least One SUD
The Centers for Medicare & Medicaid Services (CMS) on Wednesday released guidance to state Medicaid directors that clarifies how section 5052 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patient and Communities (SUPPORT) Act permits institutions for mental diseases (IMDs) to provide treatment to Medicaid beneficiaries with at least one substance use disorder (SUD).
NABH was a driving force behind section 5052 becoming law and the NABH team has talked with CMS staff about the law’s implementation.
The guidance from CMS covers five key areas: requirements for beneficiaries, requirements for IMDs, requirements for states, maintenance of effort, and interaction with existing IMD policies. This NABH Issue Brief provides a summary of each of those areas.
Requirements for Beneficiaries
An eligible individual for section 5052 (the new IMD authority) is a person who is:
Requirements for IMDs
Eligible IMDs must follow reliable, evidence-based practices and make available at least two forms of medication as part of medication-assisted treatment (MAT). The two drugs may be offered on site upon request or furnished off site by a qualified provider in the community that has an arrangement with the IMD. IMDs “should also offer behavioral health services alongside MAT,” CMS noted.
Requirements for States
States are required to:
Maintenance of Effort
Interaction with Existing IMD Policies
Section 5052 does not prevent states from pursuing or conducting a section 1115 demonstration to improve access to, and the quality of, SUD treatment for eligible populations.
CMS is developing a state plan amendment and maintenance of effort reporting templates to assist states. Click here for specific guidance related to state plan amendment submission procedures, including guidance on developing comprehensive methodologies and bundled rates.
If you have questions, please contact Scott Dziengelski, NABH’s director of policy and regulatory affairs.
March 16-18, 2020
Mandarin Oriental Washington, DC
We invite you to use this annual opportunity to learn from, connect with, and influence the decision makers who determine the future of behavioral healthcare services in the United States.
The 2020 Annual Meeting will feature sessions on a variety of issues affecting the U.S. behavioral healthcare industry, with a special emphasis on the barriers to providing and access care.
Learn more and register for the 2020 Annual Meeting
Association’s Executive VP Succeeds Retiring NABH President and CEO Mark Covall
WASHINGTON, Oct. 2, 2019 /PRNewswire/ — The National Association for Behavioral Healthcare (NABH) Board of Trustees has appointed Shawn Coughlin as its president and CEO beginning in January 2020.
Coughlin succeeds Mark Covall, who is retiring after more than 35 years with the association and 24 years as its president and CEO. The Board announced the succession plan in conjunction with its Fall Board Meeting in Washington…
Read more at PR Newswire