Today the Centers for
Medicare and Medicaid Services (CMS) issued an Informational Bulletin to
provide guidance to states regarding coverage changes for dually-eligible
beneficiaries (those enrolled in both Medicare and Medicaid) receiving
opioid treatment services. Starting January 1, 2020, Medicare will begin
paying for opioid treatment programs (OTPs) through bundled payments for
opioid use disorder (OUD) treatment services, including medication-assisted
treatment (MAT) 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 receive OTP services through Medicaid now, starting
January 1, 2020, Medicare will become the primary payer for OTP services.
In order to be reimbursed by Medicare, OTP providers will need to be
enrolled as a Medicare provider. It is possible that not all providers will
have completed 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, CMS is providing
background information on the enrollment of providers for this benefit and
clarifying options available for states to consider regarding coordination
of benefits/third party liability under Medicaid.
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