On October 24, 2018, President Trump signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act addressing the nation’s opioid overdose epidemic.
One of the goals of the SUPPORT Act is to remove obstacles to treatment, including lack of insurance coverage.
The SUPPORT Act created an OTP benefit for Medicare and Medicaid covered patients. Some states have different names for their Medicaid Programs.
OTPs provide medication-assisted treatment for people diagnosed with an Opioid Use Disorder (OUD). OTPs must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and accredited by an independent, SAMHSA-approved accrediting body.
The new benefit will cover OUD treatment services including: (1) opioid agonist and antagonist treatment medications approved by the FDA for treatment of OUD; (2) dispensing and administration of such medications; (3) substance use counseling, including counseling furnished via two-way interactive audio-video communication technology; (4) individual and group therapy, including those furnished via two-way interactive audio/video communication technology; and (5) toxicology testing, including both presumptive and definitive testing. The payment rates assume beneficiaries receive an average of two presumptive and one definitive test per month.
Providers that are interested in becoming an OTP provider are encouraged to reach out to their State’s Medicaid Agency to learn more on how to become a provider.
Effective October 2020 ALL states are mandated by the SUPPORT Act to cover the OTP benefit.
Find out more information about the OTP benefit at the Centers for Medicare & Medicaid Services website: www.cms.gov.
Health insurance companies, such as Anthem and UnitedHealthcare, which provide health care coverage to millions of Americans across the United States are starting to cover naltrexone implantable pellets. Precertification is required and covered medical benefits require review from the plan’s utilization management guidelines.
