Date: February 26, 2020
To: All Medical Assistance Program Providers
Re: Opioid Treatment Programs Medicare Coverage Effective January 1, 2020
This notice informs providers of new coverage under the Medicare program that began January 1, 2020, for Opioid Treatment Programs (OTPs).
Starting January 1, 2020, under the Calendar Year (CY) 2020 Physician Fee Schedule final rule, the Centers for Medicare & Medicaid Services (CMS) will pay Opioid Treatment Programs (OTPs) through bundled payments for opioid use disorder (OUD) treatment services in an episode of care provided to people with Medicare Part B. OTPs must enroll in the Medicare program in order to receive reimbursement when these services are provided to Medicare patients.
Under the new OTP benefit, Medicare covers:
• U.S. Food and Drug Administration (FDA)-approved opioid agonist and antagonist medication assisted treatment (MAT) medications
• Dispensing and administration of MAT medications (if applicable)
• Substance use counseling
• Individual and group therapy
• Toxicology testing
• Intake activities
• Periodic assessments
With the release of the final rule, OTPs fully-certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by a SAMHSA-approved accrediting body can start enrolling in the Medicare program, so they can bill for services starting January 1, 2020.
HFS strongly encourages OTPs to begin the Medicare enrollment process as soon as possible. Read the CMS Enrollment Fact Sheet to learn more about the enrollment process and the documentation providers need to get started.
Questions regarding provider enrollment for Medicare Part B services may be directed to the Medicare enrollment Helpline at 877-908-8476. Additional questions regarding this notice may be directed to the Bureau of Managed Care at 217-524-7478 or HFS.MMAI@illinois.gov.
Acting Medicaid Director