Resources: Reimbursement and Payment Models

Describes a benefit that covers opioid use disorder (OUD) treatment services under Medicare Part B medical insurance. Enables the Centers for Medicare & Medicaid Services (CMS) to make bundled payments to certified opioid treatment programs (OTPs) for OUD treatment services for an episode of care provided to Medicare Part B beneficiaries. Covers the following services under the benefit: opioid agonist and antagonist medication-assisted treatment (MAT) medications approved by the U.S. Food and Drug Administration (FDA), naloxone and overdose education, substance use counseling, individual and group therapy, toxicology testing, intake activities, and periodic assessments.

Offers technical assistance for clinicians in small, underserved, and rural practices to participate actively in the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP), which establishes value-based payment systems and models for clinicians serving Medicare patients. Help participants understand QPP requirements, learn about flexible options for small practices, and implement measures to improve quality and efficiency.

Assists with the provision of comprehensive and integrated substance use disorder (SUD) treatment and early intervention services for those with or at risk of developing SUD. Provides information on reimbursement coding for screening, brief intervention, and referral to treatment (SBIRT) services and related resources.