The Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (Innovation Center) is announcing the Request for Application (RFA) for a new initiative that aims to increase access to opioid use disorder (OUD) treatment services to eligible Medicare Fee-For-Service (FFS) beneficiaries, including those dually eligible for Medicare and Medicaid. This is one of a number of new initiatives required under The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT Act). The statute makes available $10,000,000 each of fiscal years 2021-2024 for demonstration payments.
Value in Opioid Use Disorder Treatment (Value in Treatment) is a four-year demonstration that creates two new payments to participating providers: 1) a per beneficiary per month care management fee (CMF) and 2) a performance-based incentive payment. These new payments will be made in addition to the OUD treatment services Medicare currently covers.
Value in Treatment participants may use these payments to furnish certain patient-centered OUD treatment services and have a reasonable expectation of improving or maintaining the health or overall function of participating beneficiaries.
The demonstration is open to a wide range of eligible participants, including:
- Individual physicians
- Group practices comprised of at least one physician or Nurse Practitioner
- Hospital outpatient departments
- Federally qualified health centers
- Rural health clinics
- Community mental health centers
- Certified community behavioral health clinics (CCBHCs)
- Opioid treatment programs (OTPs)
- Critical Access Hospitals (CAHs)