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
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.
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.