Issued: December 20, 2019
Attention Providers: Changes to OUD Treatment Services Payment Effective January 1, 2020
Partners has learned that effective January 1, 2020, Medicare will pay Opioid Treatment Programs (OTPs) through bundled payments for opioid use disorder (OUD) treatment services. These services include medication-assisted treatment (MAT), toxicology testing and counseling as authorized under Section 2005 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (Pub. L. 115-271, the SUPPORT Act) and implemented in the final rule CMS-1715-F, “Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and other Revisions to Part B for CY 2020” published in the Federal Register on November 1, 2019 (final rule).
How will this impact providers?
For dually eligible beneficiaries (those enrolled in both Medicare and Medicaid) who currently receive OTP services through Medicaid, starting on January 1, 2020, Medicare will become the primary payer for OTP services provided by Medicare-enrolled OTP providers. However, it is likely that not all OTP providers will have completed the Medicare enrollment process and have been granted the ability to bill Medicare by this date. 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 coordination of benefits/third party liability under Medicaid. Providers of OUD services are urged to read the Center for Medicare and Medicaid Services (CMS) Bulletin “Guidance to State Medicaid Agencies on Dually Eligible Beneficiaries Receiving Medicare Opioid Treatment Services Effective January 1, 2020” issued December 17, 2019.
What do providers need to do?
It is critical that providers enroll as Medicare providers as soon as possible, if not already enrolled.
What is Partners’ role?
Medicaid managed care plans (like Partners) have additional obligations to ensure parity in the coverage of mental health and substance use disorder benefits compared to medical/surgical benefits. Medicaid managed care plans must comply with 42 CFR 438.3 and part 438, subpart K
Partners will identify Medicare members currently being paid through IPRS funds to ensure Medicare is used as the primary payer. Partners anticipates more information from the State regarding this change and will share this information with affected providers.
If you have questions specific to Partners about this process, please contact your Account Specialist, or contact Partners’ Provider Helpdesk by emailing email@example.com or calling 877-864-1454.
For specific questions related to third party liability, contact Cathy Sturgill, Technical Director within the Division of Health Homes, PACE, and Coordination of Benefits/Third Party Liability at Cathy.Sturgill@cms.hhs.gov.
For specific questions related to benefits and coverage, contact Kirsten Jensen, Director, within the Division of Benefits & Coverage at Kirsten.Jensen@cms.hhs.gov.
LME-MCO Joint Communication Bulletin #J351: Payment for Interpreter Services
JCB #J351, issued by the Divisions of Health Benefits/NC Medicaid and Mental Health, Developmental Disabilities and Substance Abuse Services, outlines provider expectations regarding payment for interpreter services as well as links to DSDHH Statewide Licensed Interpreter Directories. View JCB #J351