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Understanding the CMS Proposal for Opioid Treatment Services

AAPM members have asked about the impact on their practices of the CMS proposal for opioid treatment services. Starting January 1, 2020 the Centers for Medicare & Medicaid Services (CMS) plans to pay Opioid Treatment Programs (OTPs) for opioid use disorder (OUD) treatment services, including medication-assisted treatment (MAT) medications, toxicology testing, and counseling, when given to people with Medicare Part B.

This will be a bundled payment to a program that has full certification from the Substance Abuse and Mental Health Services Administration (SAMHSA) and be accredited by a SAMHSA-approved accrediting body. The program must be enrolled in Medicare to get paid by Medicare for OUD treatment services. CMS is currently seeking public comment on the proposed policies relating to enrollment and plans to publish more information on or around November 1. The current proposal does not include direct fee-for-service payment to physicians who treat patients that are prescribed opioids or potentially misuse opioids.

CMS is also focusing on preventing and reducing opioid use disorder (OUD) by promoting safe opioid prescribing and encouraging non-opioid pain treatments. CMS issued a Request for Information to help develop an action plan to prevent opioids addictions and enhance access to medication-assisted treatment (MAT). This process expands on the “CMS Roadmap: Fighting the Opioid Crisis” that focuses on the key areas of prevention, treatment and the use of data to better understand and combat the crisis. The Roadmap can be accessed here.
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American Academy of Pain Medicine