Friday, January 4, 2019

CMS Request for Info on SUPPORT 2005 New Medicare Benefit (83 Fed Reg 59497, 2018/11/23)

Federal Register
Friday, November 23, 2018
CMS PFS Final Rulemaking for CY2019
83 Fed Reg 59497

Request for comment on how to implement SUPPORT Section 2005, New Opioid Abuse Benefit for CY2020. 

(Comment closed 12/31/2018).

Statute Section 2005, Text here.

b. Medicare Payment for Certain 
Services Furnished by Opioid 
Treatment Programs (OTPs)—Request 
for Information 

Section 2005 of the SUPPORT Act
establishes a new Medicare benefit
category for opioid use disorder
treatment services furnished by OTPs
under Medicare Part B, beginning on or
after January 1, 2020.

This provision
requires that opioid use disorder
treatment services would include:

  • FDA-approved opioid agonist and antagonist treatment medications, 
  • the dispensing and administration of such medications (if applicable), 
  • substance use disorder counseling, 
  • individual and group therapy, 
  • toxicology testing, and 
  • other services determined appropriate (but in no event to include meals and transportation). 

The provision defines
OTPs as those that enroll in Medicare
and are certified by the Substance
Abuse and Mental Health Services
Administration (SAMHSA), accredited
by a SAMHSA-approved entity, and
meeting additional conditions as the
Secretary finds necessary to ensure the
health and safety of individuals being
furnished services under these programs
and the effective and efficient
furnishing of such services.

We note that there is a 60-day period
for the public to comment on the
provisions of the interim final rule
described previously to implement
section 2001 of the SUPPORT for
Patients and Communities Act. During
that same comment period, we are 
requesting information regarding 
services furnished by OTPs, payments 
for these services, and additional 
conditions for Medicare participation 
for OTPs that stakeholders believe may 
be useful for us to consider for future 
rulemaking to implement this new 
Medicare benefit category.

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